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General NPI Number Information
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NPI Number | 1568781763
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Entity Type | Individual
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Provider Name | JASON M MOSS PHARMD, CPP
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Gender | Male
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 803 TILGHMAN DR STE 100
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City | DUNN
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State | NC
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Zip | 28334
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Country | US
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Telephone | 910-892-1091
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 ARBOR DR
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City | RALEIGH
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State | NC
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Zip | 27612-4302
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Country | US
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Telephone |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 19819
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 700152
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License Number State | NC
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