Provider Demographics
NPI:1174625099
Name:VANDIVER, MOLLY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:D
Last Name:VANDIVER
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 1:97 COUNTRY WALK
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1371
Mailing Address - Country:US
Mailing Address - Phone:215-823-4469
Mailing Address - Fax:215-823-4407
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-4469
Practice Address - Fax:215-823-4407
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044486L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy