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General NPI Number Information
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NPI Number | 1902404858
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Entity Type | Individual
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Provider Name | ANGELA LEE MOSLEY
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Gender | Female
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 2545 IL ROUTE 26 S
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City | FREEPORT
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State | IL
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Zip | 61032-9370
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Country | US
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Telephone | 815-232-8141
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Fax |
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Provider Business Mailing Address
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Address Line | W9009 BUCKHORN RD
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City | BROWNTOWN
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State | WI
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Zip | 53522-9767
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Country | US
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Telephone | 608-558-7747
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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 | 051290541
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License Number State | IL
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