Healthcare Provider Details

I. General information

NPI: 1942105150
Provider Name (Legal Business Name): CASSIDY FAY MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 GLENWOOD DR
WEST MONROE LA
71291-5501
US

IV. Provider business mailing address

113 BAYWOOD DR
WEST MONROE LA
71291-6958
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-0127
  • Fax:
Mailing address:
  • Phone: 318-547-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026474
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: