Provider Demographics
NPI:1871874578
Name:MOSS, HEATHER LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:MOSS
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 1:2473 23RD ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9193
Mailing Address - Country:US
Mailing Address - Phone:912-481-3508
Mailing Address - Fax:
Practice Address - Street 1:2111 HIGHWAY 72 N
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-5719
Practice Address - Country:US
Practice Address - Phone:865-458-9938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21885183500000X
TN40835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist