Provider Demographics
NPI:1437383148
Name:CARR, MOLLY BUSHONG
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:BUSHONG
Last Name:CARR
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 1:1372 N CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9002
Mailing Address - Country:US
Mailing Address - Phone:843-425-4505
Mailing Address - Fax:
Practice Address - Street 1:336 ROMANY RD
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2404
Practice Address - Country:US
Practice Address - Phone:859-266-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist