Provider Demographics
NPI:1144041146
Name:MOSHEYEV, DAVID JACOB (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JACOB
Last Name:MOSHEYEV
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 1:6923 171ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3314
Mailing Address - Country:US
Mailing Address - Phone:347-463-3696
Mailing Address - Fax:
Practice Address - Street 1:6923 171ST ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3314
Practice Address - Country:US
Practice Address - Phone:347-463-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist