Provider Demographics
NPI:1083964175
Name:MOSS, JOANNE LASHELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LASHELLE
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41303 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2893
Mailing Address - Country:US
Mailing Address - Phone:248-736-4835
Mailing Address - Fax:
Practice Address - Street 1:27100 WIXOM RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1115
Practice Address - Country:US
Practice Address - Phone:248-374-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist