Healthcare Provider Details

I. General information

NPI: 1457500845
Provider Name (Legal Business Name): ERNEST RAY MOXEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 N MAIN ST
SIKESTON MO
63801-4211
US

IV. Provider business mailing address

299 N MAIN ST
SIKESTON MO
63801-4211
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-7048
  • Fax: 573-481-2806
Mailing address:
  • Phone: 573-471-7048
  • Fax: 573-481-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: