Provider Demographics
NPI:1366729329
Name:MOI, ERIC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MOI
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 1:9434 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-2721
Mailing Address - Country:US
Mailing Address - Phone:773-238-5648
Mailing Address - Fax:773-238-6301
Practice Address - Street 1:9434 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2721
Practice Address - Country:US
Practice Address - Phone:773-238-5648
Practice Address - Fax:773-238-6301
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist