Provider Demographics
NPI:1326388901
Name:MOSS, PAMELA ANNETTE (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNETTE
Last Name:MOSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNETTE
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3900 BRIARGROVE LANE
Mailing Address - Street 2:APT 3105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7622
Mailing Address - Country:US
Mailing Address - Phone:501-730-4939
Mailing Address - Fax:
Practice Address - Street 1:3900 BRIARGROVE LN APT 3105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-8307
Practice Address - Country:US
Practice Address - Phone:501-730-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16029183500000X
AR7955183500000X
TX29574183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR007955Medicare Oscar/Certification