Individual
JAKE MOSSMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
622 PASEO DEL PUEBLO SUR, 5401 NDCBU, TAOS, NM 87571-5101
(505) 758-3342
Mailing address
PO BOX 942, EL PRADO, NM 87529-0942
(505) 758-8336
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4584
NM
Other
Enumeration date
03/28/2006
Last updated
07/08/2007
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