MEDICARE: ANN L MOISE

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	PS56467	FL
2	3336C0003X	Community/Retail Pharmacy		FL
3	183500000X	Pharmacist	PS61822	FL

General Provider Information

NPI Number	:	1598365660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN L MOISE

Provider Business Mailing Address
First Line	:	827 NW 10TH ST
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2113
Country	:	US
Telephone Number	:	229-296-3294
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 ANSIN BLVD STE A
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3104
Country	:	US
Telephone Number	:	305-919-7399
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/29/2020

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Directions to “ ANN L MOISE ” Practice Location

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