Provider Demographics
NPI:1013369974
Name:MOSS, KELSEY SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:SUE
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 IRAQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1077
Mailing Address - Country:US
Mailing Address - Phone:724-456-6795
Mailing Address - Fax:
Practice Address - Street 1:639 ALPHA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2819
Practice Address - Country:US
Practice Address - Phone:412-967-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450572183500000X
PARPI010569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist