Provider Demographics
NPI:1538769690
Name:MOFIELD, ALICA ANN
Entity type:Individual
Prefix:
First Name:ALICA
Middle Name:ANN
Last Name:MOFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 38TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-6603
Mailing Address - Country:US
Mailing Address - Phone:903-732-7763
Mailing Address - Fax:
Practice Address - Street 1:3855 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5210
Practice Address - Country:US
Practice Address - Phone:903-785-8734
Practice Address - Fax:903-784-0256
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist