Provider Demographics
NPI:1154723070
Name:MOORE, JERRY P (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:P
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27341-8583
Mailing Address - Country:US
Mailing Address - Phone:336-873-8246
Mailing Address - Fax:336-873-8608
Practice Address - Street 1:510 N BROAD ST
Practice Address - Street 2:
Practice Address - City:SEAGROVE
Practice Address - State:NC
Practice Address - Zip Code:27341-8583
Practice Address - Country:US
Practice Address - Phone:336-873-8246
Practice Address - Fax:336-873-8608
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist