Healthcare Provider Details

I. General information

NPI: 1073428983
Provider Name (Legal Business Name): BRIANNA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13482 ELKHORN CRK
SHELBY GAP KY
41563-8422
US

IV. Provider business mailing address

13482 ELKHORN CRK
SHELBY GAP KY
41563-8422
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-6283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026006
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: