Provider Demographics
NPI:1942304654
Name:MOSHONAS, ANTHONY G (PH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:MOSHONAS
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MONACAN PARK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-6167
Mailing Address - Country:US
Mailing Address - Phone:434-947-6156
Mailing Address - Fax:434-947-2988
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-6156
Practice Address - Fax:434-947-2988
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist