Provider Demographics
NPI:1518210137
Name:MOSER, GINA MARIE (DPH)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MOSER
Suffix:
Gender:F
Credentials:DPH
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 5450
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-5450
Mailing Address - Country:US
Mailing Address - Phone:423-413-8532
Mailing Address - Fax:
Practice Address - Street 1:110 KEITH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5868
Practice Address - Country:US
Practice Address - Phone:423-614-6650
Practice Address - Fax:423-614-6652
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist