Healthcare Provider Details

I. General information

NPI: 1922928639
Provider Name (Legal Business Name): JULIANNE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

IV. Provider business mailing address

1210 E CHILHOWIE AVE
JOHNSON CITY TN
37601-3404
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone: 828-575-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34691
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: