Provider Demographics
NPI:1639667868
Name:MOBLEY, MISSY LUANN (RPH)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:LUANN
Last Name:MOBLEY
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 1:1300 S JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041
Mailing Address - Country:US
Mailing Address - Phone:765-656-3337
Mailing Address - Fax:765-656-3220
Practice Address - Street 1:1300 S JACKSON STREET
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041
Practice Address - Country:US
Practice Address - Phone:765-656-3337
Practice Address - Fax:765-656-3220
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018356A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist