MEDICARE: MR. WILLIAM T MOORE R.PH.

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	RP044615R	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP044615R	OTHER	PA	PHARMACIST

General Provider Information

NPI Number	:	1760570303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM T MOORE R.PH.

Provider Business Mailing Address
First Line	:	140 PARK PL
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1386
Country	:	US
Telephone Number	:	717-572-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 PARK PL
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1386
Country	:	US
Telephone Number	:	717-572-3228
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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