Provider Demographics
NPI:1962590265
Name:MOSER, CHAD L (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:L
Last Name:MOSER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 17TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2739
Mailing Address - Country:US
Mailing Address - Phone:712-262-2673
Mailing Address - Fax:712-262-5469
Practice Address - Street 1:1314 17TH AVE W
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2739
Practice Address - Country:US
Practice Address - Phone:712-262-2673
Practice Address - Fax:712-262-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist