Provider Demographics
NPI:1558027128
Name:MOZEB, MUSHTAK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MUSHTAK
Middle Name:
Last Name:MOZEB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 ADDISON LOOMIS
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8685
Mailing Address - Country:US
Mailing Address - Phone:315-383-5399
Mailing Address - Fax:
Practice Address - Street 1:6789 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1640
Practice Address - Country:US
Practice Address - Phone:315-446-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist