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General NPI Number Information
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NPI Number | 1669537304
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Entity Type | Individual
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Provider Name | RANDALL R MOORE RPH
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 720 16TH AVE
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City | LEWISTON
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State | ID
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Zip | 83501-3768
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Country | US
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Telephone | 208-743-5528
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Fax | 208-746-2785
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Provider Business Mailing Address
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Address Line | 19054 PINE RIDGE LN
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City | LEWISTON
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State | ID
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Zip | 83501-5274
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Country | US
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Telephone | 208-798-5293
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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 | P3855
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License Number State | ID
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