Provider Demographics
NPI:1215099551
Name:MOON, DENNIS H (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:H
Last Name:MOON
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:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Mailing Address - Street 2:8901 WISCONSIN AVE.
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889
Mailing Address - Country:US
Mailing Address - Phone:301-295-2113
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Practice Address - Street 2:8901 WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889
Practice Address - Country:US
Practice Address - Phone:301-295-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN