Provider Demographics
NPI:1942960174
Name:MOLLO, ADRIANA MARGARET (RPH)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MARGARET
Last Name:MOLLO
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 1:25 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5048
Mailing Address - Country:US
Mailing Address - Phone:978-524-4800
Mailing Address - Fax:978-524-4809
Practice Address - Street 1:25 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5048
Practice Address - Country:US
Practice Address - Phone:978-524-4800
Practice Address - Fax:978-524-4809
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist