Provider Demographics
NPI:1407199482
Name:CYNTHIA, TAHNEEN MOONEMA (RPH)
Entity Type:Individual
Prefix:DR
First Name:TAHNEEN
Middle Name:MOONEMA
Last Name:CYNTHIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4434
Mailing Address - Country:US
Mailing Address - Phone:718-739-0311
Mailing Address - Fax:
Practice Address - Street 1:8515 KENDRICK PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2132
Practice Address - Country:US
Practice Address - Phone:646-705-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist