Healthcare Provider Details

I. General information

NPI: 1164906483
Provider Name (Legal Business Name): ANTHONY MOYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 N ARIZONA BLVD
COOLIDGE AZ
85128-3214
US

IV. Provider business mailing address

3966 W TARA DR
CHANDLER AZ
85226-4996
US

V. Phone/Fax

Practice location:
  • Phone: 520-723-5552
  • Fax:
Mailing address:
  • Phone: 623-986-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023299
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: