Provider Demographics
NPI:1639464878
Name:MOYER, FREDDIE VERNELL JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:VERNELL
Last Name:MOYER
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 GRACELAND BLVD
Mailing Address - Street 2:T-1978
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-7508
Mailing Address - Country:US
Mailing Address - Phone:614-781-9407
Mailing Address - Fax:614-781-9407
Practice Address - Street 1:55 GRACELAND BLVD
Practice Address - Street 2:T-1978
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-7508
Practice Address - Country:US
Practice Address - Phone:614-781-9407
Practice Address - Fax:614-781-9407
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist