Provider Demographics
NPI:1619125291
Name:MOSS, PHILLIP C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
Last Name:MOSS
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 1:1241 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-3345
Mailing Address - Country:US
Mailing Address - Phone:615-847-3109
Mailing Address - Fax:
Practice Address - Street 1:1241 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3345
Practice Address - Country:US
Practice Address - Phone:615-847-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist