Provider Demographics
NPI:1437737475
Name:EBERHART, MOLLI MARIE (RCPHT)
Entity Type:Individual
Prefix:
First Name:MOLLI
Middle Name:MARIE
Last Name:EBERHART
Suffix:
Gender:F
Credentials:RCPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHARLIE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-1103
Mailing Address - Country:US
Mailing Address - Phone:035-641-2349
Mailing Address - Fax:903-564-1238
Practice Address - Street 1:310 CHARLIE ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-1103
Practice Address - Country:US
Practice Address - Phone:903-821-7797
Practice Address - Fax:903-564-1238
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX293206183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician