Healthcare Provider Details

I. General information

NPI: 1164581690
Provider Name (Legal Business Name): THOMAS D MOYER BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 KANOELEHUA AVE SUITE B-3
HILO HI
96720-6500
US

IV. Provider business mailing address

668G KAUMANA DR
HILO HI
96720-1851
US

V. Phone/Fax

Practice location:
  • Phone: 808-981-2055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1258
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: