Provider Demographics
NPI:1982001582
Name:MOLINA, KETTY CARMEN (RPH)
Entity Type:Individual
Prefix:
First Name:KETTY
Middle Name:CARMEN
Last Name:MOLINA
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 1:384 TRAILVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3125
Mailing Address - Country:US
Mailing Address - Phone:760-809-6199
Mailing Address - Fax:
Practice Address - Street 1:384 TRAILVIEW RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3125
Practice Address - Country:US
Practice Address - Phone:760-809-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38433183500000X
NV08927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist