Provider Demographics
NPI:1295946531
Name:MOSLEY, LARRY KEITH (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KEITH
Last Name:MOSLEY
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 1:1300 THOMLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4336
Mailing Address - Country:US
Mailing Address - Phone:251-937-5708
Mailing Address - Fax:
Practice Address - Street 1:109 COURTHOUSE SQ
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4813
Practice Address - Country:US
Practice Address - Phone:251-937-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1012892OtherNABP