Provider Demographics
NPI:1053635094
Name:TOMOAH, MOSES (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:
Last Name:TOMOAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FIELDCREST AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3656
Mailing Address - Country:US
Mailing Address - Phone:732-572-2000
Mailing Address - Fax:800-499-8860
Practice Address - Street 1:120 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3656
Practice Address - Country:US
Practice Address - Phone:732-572-2000
Practice Address - Fax:800-499-8860
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03194200183500000X
FLPS31100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist