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General NPI Number Information
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NPI Number | 1073023099
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Entity Type | Individual
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Provider Name | CHARLOTTE K MOSS RPH
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 4375 RED ROCK RD
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City | BENTON
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State | PA
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Zip | 17814-7948
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Country | US
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Telephone | 570-925-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 80 HOLMES RD
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City | STILLWATER
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State | PA
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Zip | 17878-9219
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Country | US
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Telephone | 570-441-9603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP439100
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License Number State | PA
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