Provider Demographics
NPI:1487132825
Name:MOORE, KATHRYN G (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:G
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6659
Mailing Address - Country:US
Mailing Address - Phone:207-783-9134
Mailing Address - Fax:207-795-0804
Practice Address - Street 1:10 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6659
Practice Address - Country:US
Practice Address - Phone:207-783-9134
Practice Address - Fax:207-795-0804
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist