Provider Demographics
NPI:1538251558
Name:MOSS, ROBERT T JR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 2ND LOOP RD STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2827
Mailing Address - Country:US
Mailing Address - Phone:843-665-0289
Mailing Address - Fax:843-667-9964
Practice Address - Street 1:804 2ND LOOP RD STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2827
Practice Address - Country:US
Practice Address - Phone:843-665-0289
Practice Address - Fax:843-667-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist