Healthcare Provider Details

I. General information

NPI: 1376900761
Provider Name (Legal Business Name): MOORE RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S BROADWAY ST
MOORE OK
73160-5376
US

IV. Provider business mailing address

513 S BROADWAY ST
MOORE OK
73160-5376
US

V. Phone/Fax

Practice location:
  • Phone: 140-573-5510
  • Fax: 405-735-9523
Mailing address:
  • Phone: 405-735-5101
  • Fax: 405-735-9523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFF R MCDOWN
Title or Position: PRESIDENT/MANAGER
Credential: PHARMD
Phone: 405-735-5101