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NPI Code Detail

MEDICARE: JACQUELYN MARIE MOORE PHARM.D.

MEDICARE: JACQUELYN MARIE 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
1183500000XPharmacist18503NV
2183500000XPharmacistP6746ID
3183500000XPharmacist70425CA
4183500000XPharmacist6655MT

General Provider Information

NPI Number : 1578819728
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN MARIE MOORE PHARM.D.
Provider Business Mailing Address
First Line : 1649 MAIN ST
Second Line :
City : BILLINGS
State : MT
Zip : 59105-4043
Country : US
Telephone Number : 406-254-2947
Fax Number :
Provider Business Practice Location Address
First Line : 1649 MAIN ST
Second Line :
City : BILLINGS
State : MT
Zip : 59105-4043
Country : US
Telephone Number : 406-254-2947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2012
Last Update Date : 03/09/2022

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