MEDICARE: ELIZABETH H. MOULTON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI03436300	NJ

General Provider Information

NPI Number	:	1538441605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH H. MOULTON PHARMD

Provider Business Mailing Address
First Line	:	9255 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9255 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5322
Country	:	US
Telephone Number	:	201-854-6092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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