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General NPI Number Information
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NPI Number | 1568012383
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Entity Type | Organization
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Legal Business Name | MOORE'S PHARMACY LENA LLC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 1212 GRAND AVENUE
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City | LENA
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State | MS
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Zip | 39094
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Country | US
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Telephone | 601-780-2757
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Fax | 601-724-9438
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Provider Business Mailing Address
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Address Line | PO BOX 80
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City | LENA
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State | MS
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Zip | 39094-0080
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Country | US
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Telephone | 601-780-2757
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Fax | 601-724-9438
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BRETT CHAPIN MOORE
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Credential | PHARMD
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Telephone | 601-706-5417
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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 |
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License Number State |
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