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Individual

STEPHEN GARY MOSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM.D.

Contact information

Practice address
124 W MAIN ST, REXBURG, ID 83440-1827
(208) 356-5416
(208) 356-5653
Mailing address
124 W MAIN ST, REXBURG, ID 83440-1827
(208) 356-5416
(208) 356-5653

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5595
ID

Other

Enumeration date
10/21/2011
Last updated
10/21/2011
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