Healthcare Provider Details

I. General information

NPI: 1801913082
Provider Name (Legal Business Name): DONALD SANFORD MOISIO JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E M35
GWINN MI
49841-9160
US

IV. Provider business mailing address

853 W WASHINGTON ST
MARQUETTE MI
49855-4139
US

V. Phone/Fax

Practice location:
  • Phone: 906-346-9275
  • Fax:
Mailing address:
  • Phone: 906-225-5488
  • Fax: 906-225-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: