Provider Demographics
NPI:1780966432
Name:MOSS, CORWYN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CORWYN
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9161
Mailing Address - Country:US
Mailing Address - Phone:970-858-6584
Mailing Address - Fax:970-858-9028
Practice Address - Street 1:316 W ASPEN AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2504
Practice Address - Country:US
Practice Address - Phone:970-185-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist