Provider Demographics
NPI:1871874230
Name:MOLL, AMY MARIE (PHARMD, CCP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:MOLL
Suffix:
Gender:F
Credentials:PHARMD, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1157
Mailing Address - Country:US
Mailing Address - Phone:732-567-1535
Mailing Address - Fax:
Practice Address - Street 1:2546 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6239
Practice Address - Country:US
Practice Address - Phone:732-477-3428
Practice Address - Fax:732-477-0981
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03359200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist