Provider Demographics
NPI:1659628311
Name:MOBERG, CHRIS TYLER II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:TYLER
Last Name:MOBERG
Suffix:II
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 1:4950 GOVERNMENT BLVD
Mailing Address - Street 2:APT 189
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-5062
Mailing Address - Country:US
Mailing Address - Phone:251-753-6562
Mailing Address - Fax:
Practice Address - Street 1:13 SHELTON BEACH RD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2402
Practice Address - Country:US
Practice Address - Phone:251-675-7094
Practice Address - Fax:251-675-9139
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist