Provider Demographics
NPI:1093311433
Name:MOISEYEV, SERGEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:MOISEYEV
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HIGHWAY 66
Mailing Address - Street 2:SHOPRITE PHARMACY
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-776-8383
Mailing Address - Fax:732-775-8843
Practice Address - Street 1:2200 HIGHWAY 66
Practice Address - Street 2:SHOPRITE PHARMACY
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-8383
Practice Address - Fax:732-775-8843
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03861600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RJ07630OtherIMMUNIZATION LICENSE
NJ28RI03861600OtherPHARMACIST LICENSE