Healthcare Provider Details

I. General information

NPI: 1386017200
Provider Name (Legal Business Name): MARK ANTHONY MOYERS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 VALLEY CREEK DR
FARMINGTON MO
63640-1968
US

IV. Provider business mailing address

3107 RIDGEWOOD HILLS DR
FARMINGTON MO
63640-7758
US

V. Phone/Fax

Practice location:
  • Phone: 573-664-5202
  • Fax:
Mailing address:
  • Phone: 573-760-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: