Provider Demographics
NPI:1437976875
Name:BRETZ, MOLLIE JILL (RPH)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:JILL
Last Name:BRETZ
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:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-0694
Mailing Address - Country:US
Mailing Address - Phone:785-675-9038
Mailing Address - Fax:
Practice Address - Street 1:416 STATE ST
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1929
Practice Address - Country:US
Practice Address - Phone:785-626-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist