Provider Demographics
NPI:1740562982
Name:MOLL, MICHELLE Y (RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:Y
Last Name:MOLL
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 1:501 S. HAVENDALE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33824
Mailing Address - Country:US
Mailing Address - Phone:863-967-7518
Mailing Address - Fax:863-967-8468
Practice Address - Street 1:501 HAVENDALE BLVD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4629
Practice Address - Country:US
Practice Address - Phone:863-967-7518
Practice Address - Fax:863-967-8468
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0031056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist