=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164833182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUBREY JOSEPH MOREAU PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2014
-----------------------------------------------------
Last Update Date | 05/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14014 CONNETICUIT AVE KMART PHARMACY 4399
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-460-3402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14601 COBBLESTONE DR
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20905-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-343-6557
-----------------------------------------------------
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 | 22287
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------