Healthcare Provider Details

I. General information

NPI: 1528906906
Provider Name (Legal Business Name): AUSTIN G MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 TAMMY LITTLE DR
SECTION AL
35771-7203
US

IV. Provider business mailing address

5295 TAMMY LITTLE DR
SECTION AL
35771-7203
US

V. Phone/Fax

Practice location:
  • Phone: 256-228-7179
  • Fax: 256-228-4614
Mailing address:
  • Phone: 256-228-7179
  • Fax: 256-228-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24532
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: