Healthcare Provider Details

I. General information

NPI: 1942304654
Provider Name (Legal Business Name): ANTHONY G. MOSHONAS PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 COLONY RD
MADISON HEIGHTS VA
24572-2105
US

IV. Provider business mailing address

144 MONACAN PARK RD
MADISON HEIGHTS VA
24572-6167
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-6156
  • Fax: 434-947-2988
Mailing address:
  • Phone: 434-947-6156
  • Fax: 434-947-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202003906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: