Provider Demographics
NPI:1154650851
Name:MOSCHGAT, GERALD MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MICHAEL
Last Name:MOSCHGAT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1569
Mailing Address - Country:US
Mailing Address - Phone:814-736-4351
Mailing Address - Fax:814-736-9522
Practice Address - Street 1:617 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1569
Practice Address - Country:US
Practice Address - Phone:814-736-4351
Practice Address - Fax:814-736-9522
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030746L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP481858OtherPA STATE LICENSE #