Provider Demographics
NPI:1437562394
Name:MOLLOY, KEVIN GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GEORGE
Last Name:MOLLOY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 HAVASUPAI DR
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7512
Mailing Address - Country:US
Mailing Address - Phone:928-219-0233
Mailing Address - Fax:928-763-5919
Practice Address - Street 1:2350 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7505
Practice Address - Country:US
Practice Address - Phone:928-758-2212
Practice Address - Fax:728-763-5919
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist