Provider Demographics
NPI:1518280452
Name:MOSER, DIANNE PETREHN (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:PETREHN
Last Name:MOSER
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 1:721 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR MILL
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4409
Mailing Address - Country:US
Mailing Address - Phone:859-359-4223
Mailing Address - Fax:859-331-8304
Practice Address - Street 1:721 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:TAYLOR MILL
Practice Address - State:KY
Practice Address - Zip Code:41015-4409
Practice Address - Country:US
Practice Address - Phone:859-359-4223
Practice Address - Fax:859-331-8304
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010166183500000X
OH17586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist