Provider Demographics
NPI:1447504881
Name:DIANA MOLDON CORPORATION
Entity type:Organization
Organization Name:DIANA MOLDON CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-5241
Mailing Address - Street 1:3512 DEL PRADO BLVD CHELSEA PLACE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7259
Mailing Address - Country:US
Mailing Address - Phone:305-643-1417
Mailing Address - Fax:305-642-5241
Practice Address - Street 1:3512 DEL PRADO BLVD CHELSEA PLACE
Practice Address - Street 2:SUITE 111
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7259
Practice Address - Country:US
Practice Address - Phone:305-643-1417
Practice Address - Fax:305-642-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy