Provider Demographics
NPI:1932687001
Name:MOXIE, SAMANTHA (RPH)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MOXIE
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 1:2205 GREENVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-8792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CLAY PIKE
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2039
Practice Address - Country:US
Practice Address - Phone:724-863-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP452320OtherSTATE LICENSE