Healthcare Provider Details

I. General information

NPI: 1710231758
Provider Name (Legal Business Name): ANDREW J MOYERS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E 23RD ST
CHATTANOOGA TN
37404-5707
US

IV. Provider business mailing address

1600 E 23RD ST
CHATTANOOGA TN
37404-5707
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-4155
  • Fax: 423-622-4558
Mailing address:
  • Phone: 423-629-4155
  • Fax: 423-622-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10342
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number10342
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: