Provider Demographics
NPI:1952682817
Name:MOSS, CAMILLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:
Last Name:MOSS
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 1:6035 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2032
Mailing Address - Country:US
Mailing Address - Phone:478-757-2027
Mailing Address - Fax:478-757-0352
Practice Address - Street 1:6035 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2032
Practice Address - Country:US
Practice Address - Phone:478-757-2027
Practice Address - Fax:478-757-0352
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17462183500000X
AL11370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist