Provider Demographics
NPI:1851844013
Name:MOSS, DEBORAH LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:SOBCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2453 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2245
Mailing Address - Country:US
Mailing Address - Phone:716-876-3097
Mailing Address - Fax:
Practice Address - Street 1:2453 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-876-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-24
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist