=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023340908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVE MOYIK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2010
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1581 ROUTE 202
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10970-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-354-8980
-----------------------------------------------------
Fax | 845-354-7665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 ARDMORE ST
-----------------------------------------------------
City | NEW WINDSOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12553-8304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-534-3735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 041773-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------