Provider Demographics
NPI:1255931028
Name:MOSLEY, SUMMER JACKSON (PHARMD)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:JACKSON
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W FARMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36879-4621
Mailing Address - Country:US
Mailing Address - Phone:334-332-6106
Mailing Address - Fax:
Practice Address - Street 1:2335 BENT CREEK RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6434
Practice Address - Country:US
Practice Address - Phone:334-821-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist