MEDICARE: ERICA MOISEYEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	056115	NY

General Provider Information

NPI Number	:	1306126156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MOISEYEV

Provider Business Mailing Address
First Line	:	3165 EMMONS AVENUE
Second Line	:	3N
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	646-763-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2006
Country	:	US
Telephone Number	:	718-333-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/11/2017

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