Provider Demographics
NPI:1881294080
Name:ALLISON, MOLLIE (RPH)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:ALLISON
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 1:5115 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9648
Mailing Address - Country:US
Mailing Address - Phone:740-607-7851
Mailing Address - Fax:
Practice Address - Street 1:2850 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1723
Practice Address - Country:US
Practice Address - Phone:740-455-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist