Healthcare Provider Details

I. General information

NPI: 1326313628
Provider Name (Legal Business Name): CASSIE MOSS BOYD PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S UNION ST
MONTGOMERY AL
36130-3022
US

IV. Provider business mailing address

7017 WYNLAKES BLVD
MONTGOMERY AL
36117-7566
US

V. Phone/Fax

Practice location:
  • Phone: 334-263-8469
  • Fax:
Mailing address:
  • Phone: 334-332-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16747
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: