Provider Demographics
NPI:1073848693
Name:MOOS, DEBORAH (BS, RPH, MBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MOOS
Suffix:
Gender:F
Credentials:BS, RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 N COUNCIL RD APT 1103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4186
Mailing Address - Country:US
Mailing Address - Phone:405-728-1138
Mailing Address - Fax:
Practice Address - Street 1:1390 S DOUGLAS BLVD
Practice Address - Street 2:STE 102
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5270
Practice Address - Country:US
Practice Address - Phone:405-455-5312
Practice Address - Fax:405-455-5279
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1141971835P0018X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor