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General NPI Number Information
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NPI Number | 1558450098
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Entity Type | Individual
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Provider Name | WILLIAM DAVID MOORE SR. RPH
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 EATONTON RD STE 600
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City | MADISON
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State | GA
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Zip | 30650-4625
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Country | US
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Telephone | 706-342-2070
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Fax | 706-342-9159
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Provider Business Mailing Address
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Address Line | 1281 MADELYN LN
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City | MADISON
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State | GA
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Zip | 30650-3417
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Country | US
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Telephone | 706-342-3835
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Fax | 706-342-9159
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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 | 705139
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License Number State | GA
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