MEDICARE: AMY MOORE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13823	AL
2	183500000X	Pharmacist	0020686	CO

General Provider Information

NPI Number	:	1033709738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MOORE PHARMD

Provider Business Mailing Address
First Line	:	28 BERTHE CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 BERTHE CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3631
Country	:	US
Telephone Number	:	719-332-0877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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