Provider Demographics
NPI:1093320517
Name:MOLINE, KELLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:MOLINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:POSTHUMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2570 LAKE RIDGE RD APT 8107
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 TEASLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-4651
Practice Address - Country:US
Practice Address - Phone:940-484-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist