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General NPI Number Information
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NPI Number | 1790253235
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Entity Type | Individual
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Provider Name | MELISSA ELIZABETH MOORE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 510 GA HIGHWAY 247 S
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City | BONAIRE
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State | GA
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Zip | 31005-3865
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Country | US
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Telephone | 478-273-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 716 HICKS RD
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City | REYNOLDS
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State | GA
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Zip | 31076-2449
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Country | US
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Telephone | 706-442-9989
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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 | 20443
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 030533
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH030533
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License Number State | GA
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