Provider Demographics
NPI:1639358484
Name:MOY, WARREN (RPH)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MOY
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 1:13347 SANFORD AVE
Mailing Address - Street 2:C1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5800
Mailing Address - Country:US
Mailing Address - Phone:718-460-8318
Mailing Address - Fax:718-460-6279
Practice Address - Street 1:13347 SANFORD AVE
Practice Address - Street 2:C1D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5800
Practice Address - Country:US
Practice Address - Phone:718-460-8318
Practice Address - Fax:718-460-6279
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist