Provider Demographics
NPI:1568956985
Name:MOLLER, CODY W
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:W
Last Name:MOLLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CONSTITUTION WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-2149
Mailing Address - Country:US
Mailing Address - Phone:973-775-2150
Mailing Address - Fax:
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6116
Practice Address - Country:US
Practice Address - Phone:207-877-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPI46432390200000X
MEPR69999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program