Provider Demographics
NPI:1154659233
Name:MOLDENHAUER, MICHELE LORD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LORD
Last Name:MOLDENHAUER
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 1:704 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4582
Mailing Address - Country:US
Mailing Address - Phone:830-990-5089
Mailing Address - Fax:
Practice Address - Street 1:704 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4582
Practice Address - Country:US
Practice Address - Phone:830-990-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist