Provider Demographics
NPI:1598949448
Name:MOLINA, AGNES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
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:PO BOX 3078
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3078
Mailing Address - Country:US
Mailing Address - Phone:787-854-1097
Mailing Address - Fax:787-854-1097
Practice Address - Street 1:AVE. LOS DOMINICOS 128 LEVITTOWN
Practice Address - Street 2:LEVITVILLE SHOPPING CENTER
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0270
Practice Address - Fax:787-784-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist