Provider Demographics
NPI:1508468943
Name:MOSER, JOHN III
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOSER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5235
Mailing Address - Country:US
Mailing Address - Phone:610-449-1414
Mailing Address - Fax:
Practice Address - Street 1:116 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5235
Practice Address - Country:US
Practice Address - Phone:610-449-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist