Provider Demographics
NPI:1104521087
Name:MOLENAAR, ELSIE MARIE
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:MARIE
Last Name:MOLENAAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2619
Mailing Address - Country:US
Mailing Address - Phone:619-435-6585
Mailing Address - Fax:619-435-5914
Practice Address - Street 1:836 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2619
Practice Address - Country:US
Practice Address - Phone:619-435-6585
Practice Address - Fax:619-435-5914
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187705183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician