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General NPI Number Information
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NPI Number | 1942811674
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Entity Type | Individual
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Provider Name | MR. EVAN S MOSES
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Gender | Male
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Dates
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Enumeration Date | 08/15/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 174 MAIN ST
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City | PEABODY
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State | MA
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Zip | 01960-5644
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Country | US
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Telephone | 978-977-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 58 FRIEND ST APT 1
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City | GLOUCESTER
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State | MA
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Zip | 01930-3291
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Country | US
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Telephone | 978-412-5749
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PT24422
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License Number State | MA
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