Provider Demographics
NPI:1427385459
Name:MOORE, ROBERT LYNN (PHARMD, PHC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 UNIVERSITY BLVD NE
Mailing Address - Street 2:C/O ANTI-THROMBOSIS CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1727
Mailing Address - Country:US
Mailing Address - Phone:505-272-6202
Mailing Address - Fax:505-272-4882
Practice Address - Street 1:1209 UNIVERSITY BLVD NE
Practice Address - Street 2:C/O ANTI-THROMBOSIS CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1727
Practice Address - Country:US
Practice Address - Phone:505-272-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007360183500000X
NMPC000002261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist