Provider Demographics
NPI:1538246665
Name:MOSSOR, RICHARD CLARK (RPH MBA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CLARK
Last Name:MOSSOR
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 FOXCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2038
Mailing Address - Country:US
Mailing Address - Phone:610-355-0105
Mailing Address - Fax:
Practice Address - Street 1:780 PRIMOS AVE STE D
Practice Address - Street 2:
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032-2000
Practice Address - Country:US
Practice Address - Phone:610-583-7950
Practice Address - Fax:610-583-0462
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031280L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist