Individual
KEVIN MOULTRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12182 HIGHWAY 92, WOODSTOCK, GA 30188-4885
(770) 591-9402
Mailing address
12182 HIGHWAY 92, WOODSTOCK, GA 30188-4885
(770) 591-9402
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PHTC014196
GA
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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