Provider Demographics
NPI:1023398740
Name:MOSLEH, TARIQ
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:MOSLEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0738
Mailing Address - Country:US
Mailing Address - Phone:435-770-7331
Mailing Address - Fax:
Practice Address - Street 1:763 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3807
Practice Address - Country:US
Practice Address - Phone:801-734-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5948852-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist