Provider Demographics
NPI:1356691976
Name:MOUSSEAU, AMIE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:MOUSSEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PRESERVE DR
Mailing Address - Street 2:APT E124
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-4191
Mailing Address - Country:US
Mailing Address - Phone:910-985-0348
Mailing Address - Fax:
Practice Address - Street 1:101 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5392
Practice Address - Country:US
Practice Address - Phone:417-336-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist