Healthcare Provider Details

I. General information

NPI: 1003107020
Provider Name (Legal Business Name): WAYNE S MOORE II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

1600 ROCKLAND RD
WILMINGTON DE
19803-3607
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-5700
  • Fax: 302-651-5708
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberA1-0003439
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP438592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: