Individual
IDA MAE MOONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
506 W MARKET ST, LIMA, OH 45801-4718
(419) 222-7797
Mailing address
506 W MARKET ST, LIMA, OH 45801-4718
(419) 222-7797
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03114768
OH
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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