Provider Demographics
NPI:1770850315
Name:MOLINA, NATHAN ADAM
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ADAM
Last Name:MOLINA
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 1:56 SHANK PAINTER RD
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1342
Mailing Address - Country:US
Mailing Address - Phone:508-487-3738
Mailing Address - Fax:844-411-6582
Practice Address - Street 1:56 SHANK PAINTER RD
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1342
Practice Address - Country:US
Practice Address - Phone:508-487-3738
Practice Address - Fax:844-411-6582
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist