MEDICARE: DR. TRACEY LYNN MOORE PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	0008651	OR

General Provider Information

NPI Number	:	1548371073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY LYNN MOORE PHARM. D.

Provider Business Mailing Address
First Line	:	5684 MOONSTONE LOOP SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3517
Country	:	US
Telephone Number	:	503-362-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	5684 MOONSTONE LOOP SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3517
Country	:	US
Telephone Number	:	503-362-2627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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