Provider Demographics
NPI:1104308469
Name:MOORE, BARBARA SUE (RPH)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 CLINGAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514
Mailing Address - Country:US
Mailing Address - Phone:330-757-8787
Mailing Address - Fax:330-757-0155
Practice Address - Street 1:6615 CLINGAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-757-8787
Practice Address - Fax:330-757-0155
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist