Healthcare Provider Details

I. General information

NPI: 1427385459
Provider Name (Legal Business Name): ROBERT LYNN MOORE PHARM.D., PH.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 UNIVERSITY BLVD NE C/O ANTI-THROMBOSIS CLINIC
ALBUQUERQUE NM
87102-1727
US

IV. Provider business mailing address

1209 UNIVERSITY BLVD NE C/O ANTI-THROMBOSIS CLINIC
ALBUQUERQUE NM
87102-1727
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6202
  • Fax:
Mailing address:
  • Phone: 505-272-6202
  • Fax: 505-272-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007360
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: