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General NPI Number Information
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NPI Number | 1326524752
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Entity Type | Individual
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Provider Name | STACIE MOORE
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Gender | Female
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 10/03/2021
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Provider Practice Location Address
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Address Line | 4121 MONROE ST
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City | TOLEDO
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State | OH
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Zip | 43606-3239
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Country | US
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Telephone | 419-475-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 810 COLBURN ST
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City | TOLEDO
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State | OH
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Zip | 43609-3246
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Country | US
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Telephone | 419-514-9657
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03337418
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License Number State | OH
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