MEDICARE: DR. DIEGO CARDONA MOYETT PHARMD

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	PH1002516	MA

General Provider Information

NPI Number	:	1578424933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEGO CARDONA MOYETT PHARMD

Provider Business Mailing Address
First Line	:	160 PLEASANT ST APT 157
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02125-4871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	468 BLUE HILL AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-4308
Country	:	US
Telephone Number	:	165-947-0953
Fax Number	:

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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