Healthcare Provider Details

I. General information

NPI: 1699291609
Provider Name (Legal Business Name): BENJAMIN MOY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHINQUAPIN ROUND RD
ANNAPOLIS MD
21401-4009
US

IV. Provider business mailing address

601 CHINQUAPIN ROUND RD
ANNAPOLIS MD
21401-4009
US

V. Phone/Fax

Practice location:
  • Phone: 866-282-6700
  • Fax:
Mailing address:
  • Phone: 866-282-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25056
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: