Provider Demographics
NPI:1447774724
Name:BURNETT, MOLLY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1106
Mailing Address - Country:US
Mailing Address - Phone:610-316-9675
Mailing Address - Fax:
Practice Address - Street 1:1 S BROAD ST LBBY 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3426
Practice Address - Country:US
Practice Address - Phone:267-330-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007669700166Medicaid
P00400633OtherMEDICARE PIN
PA3998967OtherNCPDP
0282938441OtherMEDICARE NSC
PHC049OtherMEDICARE PIN