Healthcare Provider Details

I. General information

NPI: 1861772311
Provider Name (Legal Business Name): JACQUELINE MOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 25A
ORANGE CA
92868-3201
US

IV. Provider business mailing address

3518 S UNION AVE
CHICAGO IL
60609-1628
US

V. Phone/Fax

Practice location:
  • Phone: 888-267-9095
  • Fax:
Mailing address:
  • Phone: 312-753-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH87331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: