MEDICARE: MOORE HEALTHCARE INC

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	3336L0003X	Long Term Care Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	524094	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2081522	OTHER	PK

General Provider Information

NPI Number	:	1922142736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE HEALTHCARE INC

Provider Business Mailing Address
First Line	:	301 N BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-3421
Country	:	US
Telephone Number	:	918-358-2524
Fax Number	:	918-358-2588

Provider Business Practice Location Address
First Line	:	301 N BROADWAY ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-3421
Country	:	US
Telephone Number	:	918-358-2524
Fax Number	:	918-358-2588

Authorized Official
Title or Position	:	MANAGER
Name	:	GREGORY MOORE
Credential	:	DPH
Telephone Number	:	918-358-2587

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/17/2017

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Directions to “MOORE HEALTHCARE INC ” Practice Location

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