Healthcare Provider Details

I. General information

NPI: 1619503414
Provider Name (Legal Business Name): DYLAN MICHAEL MOY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 09/11/2022
Certification Date: 09/11/2022
Deactivation Date: 03/16/2020
Reactivation Date: 03/25/2020

III. Provider practice location address

1235 STRATFORD AVE
DIXON CA
95620-2024
US

IV. Provider business mailing address

417 GREEN HILLS DR
MILLBRAE CA
94030-1662
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-7402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: