Healthcare Provider Details

I. General information

NPI: 1114339157
Provider Name (Legal Business Name): BERNICE MOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2014
Last Update Date: 05/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E HARBOR CT
SACRAMENTO CA
95831-5612
US

IV. Provider business mailing address

5 E HARBOR CT
SACRAMENTO CA
95831-5612
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-9587
  • Fax:
Mailing address:
  • Phone: 916-393-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH35378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: