MEDICARE: JERRY MOORE RPH

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	183500000X	Pharmacist	37476	TX

General Provider Information

NPI Number	:	1679391197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY MOORE RPH

Provider Business Mailing Address
First Line	:	8121 BROADWAY ST STE 109
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-1340
Country	:	US
Telephone Number	:	281-888-7163
Fax Number	:	346-330-9852

Provider Business Practice Location Address
First Line	:	8121 BROADWAY ST STE 109
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-1340
Country	:	US
Telephone Number	:	281-888-7163
Fax Number	:	346-330-9852

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

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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Directions to “ JERRY MOORE RPH” Practice Location

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