Provider Demographics
NPI:1720557077
Name:MOLUH, SERGE
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:MOLUH
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 1:30 COLUMBIA AVE E STE A
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3737
Mailing Address - Country:US
Mailing Address - Phone:269-965-3237
Mailing Address - Fax:
Practice Address - Street 1:30 COLUMBIA AVE E STE A
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3737
Practice Address - Country:US
Practice Address - Phone:269-965-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist