Provider Demographics
NPI:1780981951
Name:MOLINA, DONNA MICHELE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MICHELE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:MICHELE
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:55 HELEN HWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1092
Mailing Address - Country:US
Mailing Address - Phone:706-348-1571
Mailing Address - Fax:706-348-1823
Practice Address - Street 1:55 HELEN HWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1092
Practice Address - Country:US
Practice Address - Phone:706-348-1571
Practice Address - Fax:706-348-1823
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist