MEDICARE: CATHY ANN MOORE RPH

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	PS38010	FL

General Provider Information

NPI Number	:	1316235914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY ANN MOORE RPH

Provider Business Mailing Address
First Line	:	1455 KEDRON LN
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33983-6024
Country	:	US
Telephone Number	:	941-625-7805
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 KINGS HWY
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-4214
Country	:	US
Telephone Number	:	941-629-1512
Fax Number	:	941-629-7091

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

Provider Enumeration Date	:	07/16/2011
Last Update Date	:	07/16/2011

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