Healthcare Provider Details

I. General information

NPI: 1073848693
Provider Name (Legal Business Name): DEBORAH MOOS BS, RPH, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S DOUGLAS BLVD STE 102
MIDWEST CITY OK
73130-5270
US

IV. Provider business mailing address

8301 N COUNCIL RD APT 1103
OKLAHOMA CITY OK
73132-4186
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-5312
  • Fax: 405-455-5279
Mailing address:
  • Phone: 405-728-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number114197
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: