Provider Demographics
NPI:1629315494
Name:MOSHOLDER, GERRI MOORE (RPH)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:MOORE
Last Name:MOSHOLDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 CALLANWALDE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4277
Mailing Address - Country:US
Mailing Address - Phone:678-642-9700
Mailing Address - Fax:
Practice Address - Street 1:1000 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6737
Practice Address - Country:US
Practice Address - Phone:770-932-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017829183500000X
NC09422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist