Healthcare Provider Details

I. General information

NPI: 1790085629
Provider Name (Legal Business Name): JASWANT S MOYER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 MISSOURI FLAT RD
PLACERVILLE CA
95667-5208
US

IV. Provider business mailing address

3955 MISSOURI FLAT RD
PLACERVILLE CA
95667-5208
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-2977
  • Fax: 530-295-2981
Mailing address:
  • Phone: 530-295-2977
  • Fax: 530-295-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: