Provider Demographics
NPI:1720298961
Name:MOY, DAVIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:MOY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3043
Mailing Address - Country:US
Mailing Address - Phone:847-965-1286
Mailing Address - Fax:
Practice Address - Street 1:6809 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4644
Practice Address - Country:US
Practice Address - Phone:773-237-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist