Healthcare Provider Details

I. General information

NPI: 1578819728
Provider Name (Legal Business Name): JACQUELYN MARIE MOORE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MARKET PLACE DR
GREAT FALLS MT
59404-3481
US

IV. Provider business mailing address

1601 MARKET PLACE DR
GREAT FALLS MT
59404-3481
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-0475
  • Fax: 406-771-1425
Mailing address:
  • Phone: 406-771-0475
  • Fax: 406-771-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70425
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6655
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6746
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: