Provider Demographics
NPI:1184278103
Name:MOSER, AMY GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:GRACE
Last Name:MOSER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:GRACE
Other - Last Name:FILLIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:722 W INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3574
Mailing Address - Country:US
Mailing Address - Phone:336-789-9006
Mailing Address - Fax:336-789-0537
Practice Address - Street 1:722 W INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3574
Practice Address - Country:US
Practice Address - Phone:336-789-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist