Healthcare Provider Details

I. General information

NPI: 1891001855
Provider Name (Legal Business Name): LUKE JAMES MOSELEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SISSON RD
HARWICH PORT MA
02646-1521
US

IV. Provider business mailing address

18 SISSON RD
HARWICH PORT MA
02646-1521
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-0895
  • Fax:
Mailing address:
  • Phone: 508-432-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: