Provider Demographics
NPI:1003536905
Name:CLOW, MOLLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:CLOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 MOUNT EVANS DR UNIT 129
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3775
Mailing Address - Country:US
Mailing Address - Phone:720-325-3701
Mailing Address - Fax:
Practice Address - Street 1:1900 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3355
Practice Address - Country:US
Practice Address - Phone:719-486-1846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist