=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548114028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BERARD-MOORE STUDENT PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2026
-----------------------------------------------------
Last Update Date | 02/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 GREENHOUSE RD
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02881-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-874-2761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 CAROL AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95065-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-566-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 52073
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------