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General NPI Number Information
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NPI Number | 1558517177
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Entity Type | Organization
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Legal Business Name | MOORE PHARMACY
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 1860 SHADY BROOK ST
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City | COLUMBIA
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State | TN
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Zip | 38401-3944
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Country | US
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Telephone | 931-548-8308
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Fax | 931-548-8310
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Provider Business Mailing Address
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Address Line | 1860 SHADY BROOK ST
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City | COLUMBIA
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State | TN
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Zip | 38401-3944
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Country | US
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Telephone | 931-548-8308
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Fax | 931-548-8310
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Authorized Official
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Title or Position | OWNER-PHARMACIST
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Name | DR. TERRY D. MOORE
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Credential | DPH
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Telephone | 931-548-8308
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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 | 4533
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License Number State | TN
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