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General NPI Number Information
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NPI Number | 1225999758
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Entity Type | Individual
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Provider Name | JUSTINE LYNN FREDA MOORE CPHT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 30381 CHIEFTAIN DR
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City | LOGAN
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State | OH
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Zip | 43138-9092
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Country | US
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Telephone | 740-385-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MIRANOVA PL STE 500
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City | COLUMBUS
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State | OH
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Zip | 43215-7052
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Country | US
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Telephone | 614-321-9743
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 09321448
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License Number State | OH
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