Provider Demographics
NPI:1922410901
Name:MOY-MALDONADO, LILY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:
Last Name:MOY-MALDONADO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3902
Mailing Address - Country:US
Mailing Address - Phone:602-277-1727
Mailing Address - Fax:602-277-4260
Practice Address - Street 1:1610 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3902
Practice Address - Country:US
Practice Address - Phone:602-277-1727
Practice Address - Fax:602-277-4260
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017033183500000X
NY049071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist