Provider Demographics
NPI:1073857942
Name:BOUCHER, MOLLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:BOUCHER
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 1:235 BUCKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9058
Mailing Address - Country:US
Mailing Address - Phone:717-285-2510
Mailing Address - Fax:717-285-3684
Practice Address - Street 1:155 N DONERVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1508
Practice Address - Country:US
Practice Address - Phone:717-285-2510
Practice Address - Fax:717-285-3684
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444779183500000X
PARPI002729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist