Provider Demographics
NPI:1447398326
Name:MOAK, REBECCA MALONE (D PH)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MALONE
Last Name:MOAK
Suffix:
Gender:F
Credentials:D PH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 WARWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6145
Mailing Address - Country:US
Mailing Address - Phone:865-579-1852
Mailing Address - Fax:865-215-5143
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5141
Practice Address - Fax:865-215-5143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN7609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist