Seth Moe, PHARM D.
Individual provider Active NPI Pharmacist · Three Lakes, WI
NPI 1114390887 · NPPES record last updated Jun 21, 2016
Key facts
- NPI
- 1114390887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 18272-40 (WI)
- Practice address
- 1790 Superior St
Three Lakes, WI 54562-9046 - Phone
- (715) 546-3266
- Fax
- (715) 546-2912
- NPI assigned
- Nov 3, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73797 | CA | MD | Pharmacist |
| 18272-40 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 73797 | CA | |
| Pharmacist | 183500000X | 18272-40 | WI | Yes |
Addresses
Primary practice location
1790 Superior St
Three Lakes, WI 54562-9046
Mailing address
1790 Superior St
PO Box 437
Three Lakes, WI 54562-9046
Other providers in Three Lakes, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.