Healthcare Provider Details

I. General information

NPI: 1982988531
Provider Name (Legal Business Name): ROBERT LEROY MOSER JR. BSPHARM, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHARLOIS BLVD WINSTON SALEM HEALTH CARE PHARMACY
WINSTON SALEM NC
27103-1507
US

IV. Provider business mailing address

255 CHARLOIS BLVD WINSTON SALEM HEALTH CARE PHARMACY
WINSTON SALEM NC
27103-1507
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1544
  • Fax: 336-718-1545
Mailing address:
  • Phone: 336-718-1544
  • Fax: 336-718-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06916
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: