Provider Demographics
NPI:1528336419
Name:MOORES PHARMACY INC
Entity type:Organization
Organization Name:MOORES PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-364-1416
Mailing Address - Street 1:5802 SARATOGA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4252
Mailing Address - Country:US
Mailing Address - Phone:361-653-4007
Mailing Address - Fax:361-653-4010
Practice Address - Street 1:5802 SARATOGA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4252
Practice Address - Country:US
Practice Address - Phone:361-653-4007
Practice Address - Fax:361-653-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5904645OtherNCPDP PROVIDER IDENTIFICATION NUMBER