Provider Demographics
NPI:1073023099
Name:MOSS, CHARLOTTE K (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:K
Last Name:MOSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:PA
Mailing Address - Zip Code:17878-9219
Mailing Address - Country:US
Mailing Address - Phone:570-441-9603
Mailing Address - Fax:
Practice Address - Street 1:4375 RED ROCK RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7948
Practice Address - Country:US
Practice Address - Phone:570-925-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist