Healthcare Provider Details

I. General information

NPI: 1477117893
Provider Name (Legal Business Name): PHARMOLOGY MOORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 N EASTERN AVE, SUITE F
MOORE OK
73160
US

IV. Provider business mailing address

1280 N EASTERN AVE, SUITE F
MOORE OK
73160
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-5160
  • Fax: 405-735-5164
Mailing address:
  • Phone: 405-735-5160
  • Fax: 405-735-5164

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
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW FINN
Title or Position: OFFICER
Credential:
Phone: 817-442-0484