Provider Demographics
NPI:1295916799
Name:MOON, LILIANA (RPH)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2442
Mailing Address - Country:US
Mailing Address - Phone:917-523-0703
Mailing Address - Fax:
Practice Address - Street 1:265 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4205
Practice Address - Country:US
Practice Address - Phone:973-243-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048678183500000X
NJ28RJ06106183500000X
NJ28RI03417800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist