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NPI Code Detail

MEDICARE: MICHAEL WAYNE MOORE

MEDICARE: MICHAEL WAYNE MOORE
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
1183500000XPharmacistRPH026602GA

General Provider Information

NPI Number : 1306440615
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WAYNE MOORE
Provider Business Mailing Address
First Line : 2605 HAMILTON MILL RD
Second Line :
City : BUFORD
State : GA
Zip : 30519-4106
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2605 HAMILTON MILL RD
Second Line :
City : BUFORD
State : GA
Zip : 30519-4106
Country : US
Telephone Number : 678-546-5352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2020
Last Update Date : 11/27/2020

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Directions to “ MICHAEL WAYNE MOORE ” Practice Location

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