Provider Demographics
NPI:1285760108
Name:MOSCHETTI, LILA R (RPH)
Entity type:Individual
Prefix:MRS
First Name:LILA
Middle Name:R
Last Name:MOSCHETTI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:SHADY COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97539-0700
Mailing Address - Country:US
Mailing Address - Phone:541-878-3151
Mailing Address - Fax:541-878-8228
Practice Address - Street 1:21195 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-9715
Practice Address - Country:US
Practice Address - Phone:541-878-3151
Practice Address - Fax:541-878-8228
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9252183500000X
ORRPH-00092521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist