Provider Demographics
NPI:1154955003
Name:MOORE, BRETT CHAPIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CHAPIN
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 1:711 ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9616
Mailing Address - Country:US
Mailing Address - Phone:601-706-5417
Mailing Address - Fax:601-724-9438
Practice Address - Street 1:1212 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:MS
Practice Address - Zip Code:39094-9580
Practice Address - Country:US
Practice Address - Phone:601-780-2757
Practice Address - Fax:601-724-9438
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist