Healthcare Provider Details

I. General information

NPI: 1902525744
Provider Name (Legal Business Name): KAILEY BREANNE MOSS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071 BOX MDG
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071 BOX MDG
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-3510
  • Fax:
Mailing address:
  • Phone: 315-225-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10211
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: