Provider Demographics
NPI:1407102379
Name:MOSELEY, MICHELLE V (RPH,PHARMD,BCPS,BCGP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:V
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:RPH,PHARMD,BCPS,BCGP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:N
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH,PHARMD
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1433
Mailing Address - Country:US
Mailing Address - Phone:615-828-6559
Mailing Address - Fax:
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:615-828-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN366121835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy