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NPI Code Detail

MEDICARE: MOLLIE JAY PHARMD

MEDICARE: MOLLIE JAY PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist3202WY

General Provider Information

NPI Number : 1295043909
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE JAY PHARMD
Provider Business Mailing Address
First Line : 1607 MITCHELL ST
Second Line :
City : LARAMIE
State : WY
Zip : 82072-2398
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-742-7246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2010
Last Update Date : 09/15/2010

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Directions to “ MOLLIE JAY PHARMD” Practice Location

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