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General NPI Number Information
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NPI Number | 1942105150
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Entity Type | Individual
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Provider Name | CASSIDY FAY MOORE
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Gender | Female
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 1025 GLENWOOD DR
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City | WEST MONROE
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State | LA
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Zip | 71291-5501
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Country | US
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Telephone | 318-322-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 113 BAYWOOD DR
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City | WEST MONROE
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State | LA
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Zip | 71291-6958
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Country | US
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Telephone | 318-547-0641
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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 | PST.026474
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License Number State | LA
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