Provider Demographics
NPI:1457942328
Name:MOON, NEGIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NEGIN
Middle Name:
Last Name:MOON
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 1:1795 PRESIDENTIAL CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5644
Mailing Address - Country:US
Mailing Address - Phone:770-807-0137
Mailing Address - Fax:
Practice Address - Street 1:1795 PRESIDENTIAL CIR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5644
Practice Address - Country:US
Practice Address - Phone:770-807-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist