Provider Demographics
NPI:1538614805
Name:MOZINGO, PHILLIP (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MOZINGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 HOBART DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6213
Mailing Address - Country:US
Mailing Address - Phone:843-992-2654
Mailing Address - Fax:
Practice Address - Street 1:119 W BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3002
Practice Address - Country:US
Practice Address - Phone:803-435-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist