Provider Demographics
NPI:1598365660
Name:MOISE, ANN L
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:MOISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2113
Mailing Address - Country:US
Mailing Address - Phone:229-296-3294
Mailing Address - Fax:
Practice Address - Street 1:400 ANSIN BLVD STE A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3104
Practice Address - Country:US
Practice Address - Phone:305-919-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56467183500000X
FL3336C0003X
FLPS61822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy