Provider Demographics
NPI:1003162017
Name:MOSER, MATTHEW RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
Last Name:MOSER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 N WICKHAM RD
Mailing Address - Street 2:T-1934
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8455 N WICKHAM RD
Practice Address - Street 2:T-1934
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6607
Practice Address - Country:US
Practice Address - Phone:321-752-1870
Practice Address - Fax:321-775-6333
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist