Provider Demographics
NPI:1740527324
Name:MOSS, TANYA RAE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:RAE
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7578 SE MARICAMP RD
Mailing Address - Street 2:#100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-4273
Mailing Address - Country:US
Mailing Address - Phone:352-687-2464
Mailing Address - Fax:352-687-3612
Practice Address - Street 1:7578 SE MARICAMP RD
Practice Address - Street 2:#100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-4273
Practice Address - Country:US
Practice Address - Phone:352-687-2464
Practice Address - Fax:352-687-3612
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist