=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023185014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD EARL MOORE JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 E C ST
-----------------------------------------------------
City | BUTNER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27509-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-515-1285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1614 CALIPER WAY
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27713-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-361-2149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16531
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------