Healthcare Provider Details

I. General information

NPI: 1740350719
Provider Name (Legal Business Name): JULIA R. MOORE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

9740 BRANDEWIE ROAD
FORT LORAMIE OH
45845-9719
US

V. Phone/Fax

Practice location:
  • Phone: 937-473-3333
  • Fax:
Mailing address:
  • Phone: 937-726-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-24723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: