MEDICARE: DR. CARLA DALE MOORE PHARMD, MBA

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	61510	TX

General Provider Information

NPI Number	:	1124723010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLA DALE MOORE PHARMD, MBA

Provider Business Mailing Address
First Line	:	8110 PARK LN APT 520
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6092
Country	:	US
Telephone Number	:	469-452-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 N HASKELL AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3707
Country	:	US
Telephone Number	:	214-370-5558
Fax Number	:	972-656-4731

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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