Healthcare Provider Details

I. General information

NPI: 1982969887
Provider Name (Legal Business Name): JAMES JUDE MOORE JR. PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2012
Last Update Date: 07/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST TEMPLE UNIVERSITY HOSPITAL
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

11901 WALDEMIRE DR
PHILADELPHIA PA
19154-2616
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2000
  • Fax:
Mailing address:
  • Phone: 215-901-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP445514
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: