Provider Demographics
NPI:1851672448
Name:MOY, JENNIE
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1031 ESTANCIA LN
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6317
Mailing Address - Country:US
Mailing Address - Phone:847-401-1735
Mailing Address - Fax:
Practice Address - Street 1:315 N IL ROUTE 31
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3778
Practice Address - Country:US
Practice Address - Phone:815-404-2643
Practice Address - Fax:815-404-2649
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist