Healthcare Provider Details

I. General information

NPI: 1487258547
Provider Name (Legal Business Name): SARA KATHERINE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 MOODY PKWY
MOODY AL
35004-3101
US

IV. Provider business mailing address

3000 LILY CIR
MOODY AL
35004-4001
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-7166
  • Fax:
Mailing address:
  • Phone: 334-559-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16559
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: