Provider Demographics
NPI:1457628364
Name:MOUA, TOU G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TOU
Middle Name:G
Last Name:MOUA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 N LIBERTY LAKE RD # 351
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8523
Mailing Address - Country:US
Mailing Address - Phone:509-468-1215
Mailing Address - Fax:
Practice Address - Street 1:12 E EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1706
Practice Address - Country:US
Practice Address - Phone:509-325-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist