Jay Mosley, RPH
Individual provider Active NPI Pharmacist · Lyons, GA
NPI 1861552887 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1861552887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 12609 (GA)
- Practice address
- 160 S Victory Dr
Lyons, GA 30436-1444 - Phone
- (912) 526-8531
- Fax
- (912) 526-0248
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12609 | GA | MD | Pediatric Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walker Pharmacy and Gifts, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12609 | GA | Yes |
Addresses
Primary practice location
160 S Victory Dr
Lyons, GA 30436-1444
Mailing address
276 Collins St
Lyons, GA 30436-4703
Phone (912) 526-8637
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12609 | Other | GA | STATE LICENSE # |
| 1111525 | Other | GA | NABP # |
Other providers in Lyons, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.