Provider Demographics
NPI:1013589571
Name:MOSES, HANNAH FAITH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:FAITH
Last Name:MOSES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:FAITH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24760 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671
Mailing Address - Country:US
Mailing Address - Phone:218-679-3912
Mailing Address - Fax:
Practice Address - Street 1:24760 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP96211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP9621OtherPHARMACIST LICENSE