Healthcare Provider Details

I. General information

NPI: 1285910034
Provider Name (Legal Business Name): TIARA MOYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MARKET ST
ROCKLAND MA
02370-2603
US

IV. Provider business mailing address

75 MARKET ST
ROCKLAND MA
02370-2603
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-5849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH26216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: