Provider Demographics
NPI:1164581690
Name:MOYER, THOMAS D (BS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:MOYER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668G KAUMANA DR
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 KANOELEHUA AVE
Practice Address - Street 2:SUITE B-3
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6500
Practice Address - Country:US
Practice Address - Phone:808-981-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist