Provider Demographics
NPI:1568012383
Name:MOORE'S PHARMACY LENA LLC
Entity type:Organization
Organization Name:MOORE'S PHARMACY LENA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:CHAPIN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-706-5417
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:MS
Mailing Address - Zip Code:39094-0080
Mailing Address - Country:US
Mailing Address - Phone:601-780-2757
Mailing Address - Fax:601-724-9438
Practice Address - Street 1:1212 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:MS
Practice Address - Zip Code:39094
Practice Address - Country:US
Practice Address - Phone:601-780-2757
Practice Address - Fax:601-724-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06620077Medicaid