Provider Demographics
NPI:1174329932
Name:MOFFETT, WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S PEARSON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-5637
Mailing Address - Country:US
Mailing Address - Phone:601-914-4848
Mailing Address - Fax:601-292-7700
Practice Address - Street 1:238 S PEARSON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-5637
Practice Address - Country:US
Practice Address - Phone:601-914-4848
Practice Address - Fax:601-292-7700
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist