Provider Demographics
NPI:1427238880
Name:MOSHER, MARTHA GRACE (RPH)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:GRACE
Last Name:MOSHER
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 1:127 CASTLE ST
Mailing Address - Street 2:C/O RITE AID PHARMACY
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2609
Mailing Address - Country:US
Mailing Address - Phone:315-781-2903
Mailing Address - Fax:315-781-2268
Practice Address - Street 1:127 CASTLE ST
Practice Address - Street 2:C/O RITE AID PHARMACY
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2609
Practice Address - Country:US
Practice Address - Phone:315-781-2903
Practice Address - Fax:315-781-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038564OtherNY STATE LICENSE