Provider Demographics
NPI:1831581909
Name:MOULTON, JOHN BARSON II (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARSON
Last Name:MOULTON
Suffix:II
Gender:M
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 1:343 LEE ROAD 593
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-7943
Mailing Address - Country:US
Mailing Address - Phone:706-442-1377
Mailing Address - Fax:
Practice Address - Street 1:343 LEE ROAD 593
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-7943
Practice Address - Country:US
Practice Address - Phone:706-442-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17772183500000X
GARPH028223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17772OtherALABAMA BOARD OF PHARMACY
GARPH028223OtherGEORGIA BOARD OF PHARMACY