1285760108 NPI number — MRS. LILA R MOSCHETTI RPH

Table of content: MRS. LILA R MOSCHETTI RPH (NPI 1285760108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285760108 NPI number — MRS. LILA R MOSCHETTI RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSCHETTI
Provider First Name:
LILA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285760108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHADY COVE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97539-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-878-3151
Provider Business Mailing Address Fax Number:
541-878-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21195 HIGHWAY 62
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHADY COVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97539-9715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-878-3151
Provider Business Practice Location Address Fax Number:
541-878-8228
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  9252 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: RPH-0009252 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)