Provider Demographics
NPI:1053605311
Name:DAVIS, MOLLY (PHARMD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 RIVER RD
Mailing Address - Street 2:T2433
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-3253
Mailing Address - Country:US
Mailing Address - Phone:860-823-2961
Mailing Address - Fax:
Practice Address - Street 1:195 RIVER RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3253
Practice Address - Country:US
Practice Address - Phone:860-823-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist