Healthcare Provider Details

I. General information

NPI: 1487362992
Provider Name (Legal Business Name): CHARLES GRAYBILL MOYE SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W. 6TH STREET
WAYNESBORO GA
30830
US

IV. Provider business mailing address

119 W. 6TH STREET
WAYNESBORO GA
30830
US

V. Phone/Fax

Practice location:
  • Phone: 706-554-7000
  • Fax:
Mailing address:
  • Phone: 706-554-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH012199
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: