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General NPI Number Information
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NPI Number | 1598123796
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Entity Type | Individual
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Provider Name | ELLEN MOORE RPH
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Gender | Female
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 381 MARKET SQUARE DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-8721
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Country | US
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Telephone | 606-759-7973
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Fax | 606-759-2031
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Provider Business Mailing Address
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Address Line | 3125 S COLLINS RD
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City | DOVER
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State | KY
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Zip | 41034-9618
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Country | US
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Telephone | 606-407-5130
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 010552
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License Number State | KY
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