Provider Demographics
NPI:1962223479
Name:MOLL, MAKENNA LEIGH (PHARM D)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:LEIGH
Last Name:MOLL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3237
Mailing Address - Country:US
Mailing Address - Phone:585-957-9946
Mailing Address - Fax:
Practice Address - Street 1:1829 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3237
Practice Address - Country:US
Practice Address - Phone:585-957-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist