MEDICARE: DR. BRETT CHAPIN 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	E-15068	MS

General Provider Information

NPI Number	:	1154955003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT CHAPIN MOORE PHARMD

Provider Business Mailing Address
First Line	:	711 ADAIR ST
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-9616
Country	:	US
Telephone Number	:	601-706-5417
Fax Number	:	601-724-9438

Provider Business Practice Location Address
First Line	:	1212 GRAND AVE
Second Line	:
City	:	LENA
State	:	MS
Zip	:	39094-9580
Country	:	US
Telephone Number	:	601-780-2757
Fax Number	:	601-724-9438

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

Provider Enumeration Date	:	03/01/2020
Last Update Date	:	03/01/2020

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