Provider Demographics
NPI:1518293000
Name:MOLLER, BARRY JAMES (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JAMES
Last Name:MOLLER
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2007
Mailing Address - Country:US
Mailing Address - Phone:619-424-8612
Mailing Address - Fax:619-424-6331
Practice Address - Street 1:1854 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2007
Practice Address - Country:US
Practice Address - Phone:619-424-8612
Practice Address - Fax:619-424-6331
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 60870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist