Provider Demographics
NPI:1235217175
Name:MOLLICA, LISA RAE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RAE
Last Name:MOLLICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5303
Mailing Address - Country:US
Mailing Address - Phone:724-439-9402
Mailing Address - Fax:
Practice Address - Street 1:92 N MORGANTOWN ST
Practice Address - Street 2:
Practice Address - City:FAIRCHANCE
Practice Address - State:PA
Practice Address - Zip Code:15436-1038
Practice Address - Country:US
Practice Address - Phone:724-564-1700
Practice Address - Fax:724-564-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist