Provider Demographics
NPI:1528377538
Name:MOZINGO, DAVID BRIAN (PHARMD, MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:MOZINGO
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7624
Mailing Address - Country:US
Mailing Address - Phone:910-822-4965
Mailing Address - Fax:
Practice Address - Street 1:3300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7624
Practice Address - Country:US
Practice Address - Phone:910-822-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist