Provider Demographics
NPI:1255543724
Name:MOSHER, STEVEN L (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MOSHER
Suffix:
Gender:M
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:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-1233
Mailing Address - Country:US
Mailing Address - Phone:915-764-2739
Mailing Address - Fax:915-764-3661
Practice Address - Street 1:1420 FABENS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838
Practice Address - Country:US
Practice Address - Phone:915-764-2739
Practice Address - Fax:915-764-3661
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist