Provider Demographics
NPI:1164183281
Name:MINER, MOLLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MINER
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 1:1605 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1027
Mailing Address - Country:US
Mailing Address - Phone:712-370-0507
Mailing Address - Fax:
Practice Address - Street 1:1605 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1027
Practice Address - Country:US
Practice Address - Phone:712-623-3370
Practice Address - Fax:712-623-2839
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist