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General NPI Number Information
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NPI Number | 1487258547
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Entity Type | Individual
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Provider Name | SARA KATHERINE MOORE
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Gender | Female
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 2828 MOODY PKWY
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City | MOODY
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State | AL
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Zip | 35004-3101
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Country | US
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Telephone | 205-640-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 LILY CIR
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City | MOODY
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State | AL
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Zip | 35004-4001
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Country | US
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Telephone | 334-559-1044
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16559
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License Number State | AL
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