Provider Demographics
NPI:1679652887
Name:MOSLEY, STEPHANIE SUZANNAH (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUZANNAH
Last Name:MOSLEY
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 1:127 LAMPLIGHTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8649
Mailing Address - Country:US
Mailing Address - Phone:304-594-0047
Mailing Address - Fax:
Practice Address - Street 1:127 LAMPLIGHTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8649
Practice Address - Country:US
Practice Address - Phone:304-594-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004708183500000X
PARP044737R183500000X
OH03-2-18020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist