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General NPI Number Information
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NPI Number | 1629228358
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Entity Type | Individual
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Provider Name | CHARLES S. MOSS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 409 MULBERRY AVE
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City | SELMER
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State | TN
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Zip | 38375-2307
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Country | US
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Telephone | 731-645-4423
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Fax |
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Provider Business Mailing Address
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Address Line | 11 COUNTY ROAD 676
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City | CORINTH
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State | MS
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Zip | 38834-7419
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Country | US
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Telephone | 662-223-9015
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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 | 11120
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T08597
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12812
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License Number State | AL
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