Provider Demographics
NPI:1710200746
Name:MOLIK, ANNETTE RUCH
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RUCH
Last Name:MOLIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9556
Mailing Address - Country:US
Mailing Address - Phone:716-549-0324
Mailing Address - Fax:716-549-0523
Practice Address - Street 1:9050 ERIE RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9556
Practice Address - Country:US
Practice Address - Phone:716-549-0324
Practice Address - Fax:716-549-0523
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist