Healthcare Provider Details

I. General information

NPI: 1609065598
Provider Name (Legal Business Name): DANIEL J MOYER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 WISCONSIN AVE
RACINE WI
53403-1987
US

IV. Provider business mailing address

1244 WISCONSIN AVE
RACINE WI
53403-1987
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-2150
  • Fax: 262-687-5500
Mailing address:
  • Phone: 262-687-2150
  • Fax: 262-687-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12594-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: