Provider Demographics
NPI:1235118373
Name:MOLINA, SHIRLEY G (TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:G
Last Name:MOLINA
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 87TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3361
Mailing Address - Country:US
Mailing Address - Phone:360-651-8804
Mailing Address - Fax:
Practice Address - Street 1:6126 87TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3361
Practice Address - Country:US
Practice Address - Phone:360-651-8804
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00056467183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician