Provider Demographics
NPI:1518387877
Name:MOSS, ANGELA CAROLINA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROLINA
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1268
Mailing Address - Country:US
Mailing Address - Phone:864-489-8704
Mailing Address - Fax:864-489-9407
Practice Address - Street 1:165 WALTON DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1268
Practice Address - Country:US
Practice Address - Phone:864-489-8704
Practice Address - Fax:864-489-9407
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist