=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063982718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA MOYER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2018
-----------------------------------------------------
Last Update Date | 11/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2759 PAPERMILL RD
-----------------------------------------------------
City | WYOMISSING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19610-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-736-9333
-----------------------------------------------------
Fax | 610-736-9335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 SELTZER AVE
-----------------------------------------------------
City | WOMELSDORF
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19567-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-310-5472
-----------------------------------------------------
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 | RP041816L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------