MEDICARE: DR. KELSEY MOSES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S020720	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679973242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY MOSES RPH

Provider Business Mailing Address
First Line	:	10727 W OLIVE AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-9202
Country	:	US
Telephone Number	:	623-815-8074
Fax Number	:	623-876-4124

Provider Business Practice Location Address
First Line	:	10727 W OLIVE AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-9202
Country	:	US
Telephone Number	:	623-815-8074
Fax Number	:	623-876-4124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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