Healthcare Provider Details

I. General information

NPI: 1669399283
Provider Name (Legal Business Name): ALEXIS MOY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

3027 S ARCH ST
CHICAGO IL
60608-5511
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26031449A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: