Provider Demographics
NPI:1427343821
Name:MOY, JEAN D (PHARMD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:D
Last Name:MOY
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 1:1940 W 33RD ST
Mailing Address - Street 2:T-2078
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6107
Mailing Address - Country:US
Mailing Address - Phone:773-843-3267
Mailing Address - Fax:773-843-3261
Practice Address - Street 1:1940 W 33RD ST
Practice Address - Street 2:T-2078
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6107
Practice Address - Country:US
Practice Address - Phone:773-843-3267
Practice Address - Fax:773-843-3261
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist