Provider Demographics
NPI:1992551295
Name:MOYERS, MAITE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:MOYERS
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 1:14155 DALLAS PKWY APT 1325
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4447
Mailing Address - Country:US
Mailing Address - Phone:915-227-0040
Mailing Address - Fax:
Practice Address - Street 1:2454 JUPITER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4904
Practice Address - Country:US
Practice Address - Phone:972-578-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy