Healthcare Provider Details

I. General information

NPI: 1598365660
Provider Name (Legal Business Name): ANN L MOISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ANSIN BLVD STE A
HALLANDALE BEACH FL
33009-3104
US

IV. Provider business mailing address

827 NW 10TH ST
HALLANDALE BEACH FL
33009-2113
US

V. Phone/Fax

Practice location:
  • Phone: 305-919-7399
  • Fax:
Mailing address:
  • Phone: 229-296-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56467
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: