Healthcare Provider Details

I. General information

NPI: 1952210643
Provider Name (Legal Business Name): JAMES MOORE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N SMITH RD APT 10A
BLOOMINGTON IN
47408-2977
US

IV. Provider business mailing address

800 N SMITH RD APT 10A
BLOOMINGTON IN
47408-2977
US

V. Phone/Fax

Practice location:
  • Phone: 217-552-7659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032146A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: