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General NPI Number Information
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NPI Number | 1477154664
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Entity Type | Individual
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Provider Name | DONALD RAYMOND MOORE PHARM. D
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Gender | Male
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 4810 NORTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1876
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Country | US
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Telephone | 936-564-1158
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Fax | 936-564-1035
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Provider Business Mailing Address
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Address Line | 3743 TUDOR DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-5817
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Country | US
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Telephone | 936-645-4836
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 31926
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License Number State | TX
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