Healthcare Provider Details

I. General information

NPI: 1699304055
Provider Name (Legal Business Name): ASHLEY NICOLE MOYE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 US HIGHWAY 45 N
ELDORADO IL
62930-3768
US

IV. Provider business mailing address

15700 HIGHWAY 1
RIDGWAY IL
62979-2104
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-4941
  • Fax:
Mailing address:
  • Phone: 618-272-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.290007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: