MEDICARE: RENEE ASHLEY MOSS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11560	TN

General Provider Information

NPI Number	:	1831495753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ASHLEY MOSS RPH

Provider Business Mailing Address
First Line	:	508 FOWLER FORD RD
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1940
Country	:	US
Telephone Number	:	615-323-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 W KNIGHT ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1415
Country	:	US
Telephone Number	:	615-325-4141
Fax Number	:	615-325-7423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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Directions to “ RENEE ASHLEY MOSS RPH” Practice Location

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