Provider Demographics
NPI:1467633883
Name:MOSHER, LORI J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:J
Last Name:MOSHER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SCHROON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-4807
Mailing Address - Country:US
Mailing Address - Phone:518-623-9956
Mailing Address - Fax:
Practice Address - Street 1:1 PALMER AVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1121
Practice Address - Country:US
Practice Address - Phone:518-654-7464
Practice Address - Fax:518-654-7826
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist