1861668436 NPI number — DR. MOLLY PATRICIA ALLEN PHARMD

Table of content: DR. MOLLY PATRICIA ALLEN PHARMD (NPI 1861668436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861668436 NPI number — DR. MOLLY PATRICIA ALLEN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
MOLLY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRAUS
Provider Other First Name:
MOLLY
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861668436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 N ROSS ST
Provider Second Line Business Mailing Address:
PO BOX 458
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48612-8165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-435-7727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 N ROSS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48612-8165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-435-7727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302033629 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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