Provider Demographics
NPI:1316305998
Name:MOUGHON, NANCY B (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:MOUGHON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 S SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2442
Mailing Address - Country:US
Mailing Address - Phone:703-266-3784
Mailing Address - Fax:
Practice Address - Street 1:13610 S SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-2442
Practice Address - Country:US
Practice Address - Phone:703-266-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist