Provider Demographics
NPI:1366982654
Name:MOE, COURTNEY (RPH)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MOE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:10650 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2476
Mailing Address - Country:US
Mailing Address - Phone:210-659-8177
Mailing Address - Fax:210-659-9169
Practice Address - Street 1:10650 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2476
Practice Address - Country:US
Practice Address - Phone:210-659-8177
Practice Address - Fax:210-659-9169
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX57478OtherPHARMACY LICENSE