Provider Demographics
NPI:1255428298
Name:MOSES, CHAD TAYLOR (PHARM D)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:TAYLOR
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:EAST HWY 262
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534
Mailing Address - Country:US
Mailing Address - Phone:435-651-3291
Mailing Address - Fax:435-651-3463
Practice Address - Street 1:EAST HWY 262
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534
Practice Address - Country:US
Practice Address - Phone:435-651-3291
Practice Address - Fax:435-651-3463
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58726061701183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy