Provider Demographics
NPI:1174830756
Name:MOUA, ABEL TXONBENG
Entity Type:Individual
Prefix:DR
First Name:ABEL
Middle Name:TXONBENG
Last Name:MOUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 JOE H STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-8570
Mailing Address - Country:US
Mailing Address - Phone:864-578-9631
Mailing Address - Fax:
Practice Address - Street 1:1320 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1416
Practice Address - Country:US
Practice Address - Phone:864-489-3129
Practice Address - Fax:864-488-1248
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH12861183500000X
MAPH232761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist