Healthcare Provider Details

I. General information

NPI: 1366150807
Provider Name (Legal Business Name): BONNY MOY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PIERCE PL FL 10
ITASCA IL
60143-1253
US

IV. Provider business mailing address

1119 HAMLET RD
NAPERVILLE IL
60564-4151
US

V. Phone/Fax

Practice location:
  • Phone: 847-727-0118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051293929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: