Provider Demographics
NPI:1023503968
Name:MOSES, JEREMY GLENN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:GLENN
Last Name:MOSES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14571 WATERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-1608
Mailing Address - Country:US
Mailing Address - Phone:256-227-8080
Mailing Address - Fax:
Practice Address - Street 1:1011 US HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4319
Practice Address - Country:US
Practice Address - Phone:256-233-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist