Provider Demographics
NPI:1669588521
Name:MOSER, MICHELLE K (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:MOSER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3307
Mailing Address - Country:US
Mailing Address - Phone:360-757-6677
Mailing Address - Fax:360-757-6888
Practice Address - Street 1:839 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3307
Practice Address - Country:US
Practice Address - Phone:360-757-6677
Practice Address - Fax:360-757-6888
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014323183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy