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General NPI Number Information
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NPI Number | 1194023820
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Entity Type | Individual
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Provider Name | ADAM RHETT MOORE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 2704 N OAK ST BLDG B1
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-244-5353
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Fax | 229-244-5357
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Provider Business Mailing Address
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Address Line | 2704 N OAK ST BLDG B1
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City | VALDOSTA
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State | GA
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Zip | 31602-1771
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Country | US
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Telephone | 229-244-5353
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Fax | 229-244-5357
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 022529
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License Number State | GA
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