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General NPI Number Information
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NPI Number | 1982002275
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Entity Type | Individual
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Provider Name | BO YOUNG MOON
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Gender | Female
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 127 S BROADWAY
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City | YONKERS
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State | NY
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Zip | 10701-4006
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Country | US
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Telephone | 914-378-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 3 DUNDERAVE RD
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City | WHITE PLAINS
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State | NY
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Zip | 10603-3009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 058276
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License Number State | NY
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