Provider Demographics
NPI:1174819833
Name:MOSLEY, MANUEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:MOSLEY
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 1:1801 S LOOP 288
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4801
Mailing Address - Country:US
Mailing Address - Phone:940-220-2123
Mailing Address - Fax:940-220-2123
Practice Address - Street 1:1801 S LOOP 288
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4801
Practice Address - Country:US
Practice Address - Phone:940-220-2123
Practice Address - Fax:940-220-2123
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist