Provider Demographics
NPI:1942550165
Name:MOLETTE, EDWARD ALEXANDER (RPH, PHARM-D)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALEXANDER
Last Name:MOLETTE
Suffix:
Gender:M
Credentials:RPH, PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20255 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6815
Mailing Address - Country:US
Mailing Address - Phone:623-572-7192
Mailing Address - Fax:
Practice Address - Street 1:20255 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6815
Practice Address - Country:US
Practice Address - Phone:623-572-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist