Moon Lake Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH 22873 Issued in FL

Legal business name

MOON LAKE PHARMACY

Practice address

9111 Ridge Rd
New Port Richey, FL 34654-5059

Phone

(727) 846-1800

Fax

(727) 846-1822

NPI assigned

Oct 16, 2007

Last updated

Oct 16, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vivian Alberto

Title

President

Phone

(727) 846-1800

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1053500066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9111 RIDGE RD",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346545059",
            "telephone_number": "727-846-1800",
            "fax_number": "727-846-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9111 RIDGE RD",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346545059",
            "telephone_number": "727-846-1800",
            "fax_number": "727-846-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON LAKE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "ALBERTO",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-846-1800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH 22873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Montemayor, DC
• Daniel Montgomery
• Robert Joseph Montgomery, RPH
• Natalie Lama Monticciolo, D.O.
• Sherri L Montiy, RN
• Amanda Moore Heuman, M.S., CCC-SLP
• Allison Kathleen Moore, MS, SLP
• Casey Blaine Moore, APRN
• Crystal Lynn Moore
• Gary Thomas Moore

• Community/Retail Pharmacy in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.