Healthcare Provider Details

I. General information

NPI: 1467793737
Provider Name (Legal Business Name): ROBERT KEITH MOKSZYCKI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY ST
FORT BRAGG NC
28310-7324
US

IV. Provider business mailing address

116 PURPLE MARTIN PL
FAYETTEVILLE NC
28306-8262
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8748
  • Fax:
Mailing address:
  • Phone: 518-929-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number055167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: