Provider Demographics
NPI:1275135816
Name:MOSHER, MARTHA T (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:T
Last Name:MOSHER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 GRANT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-1017
Mailing Address - Country:US
Mailing Address - Phone:915-544-6605
Mailing Address - Fax:915-532-6073
Practice Address - Street 1:2002 GRANT AVE STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-1017
Practice Address - Country:US
Practice Address - Phone:915-544-6605
Practice Address - Fax:915-532-6073
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist