Provider Demographics
NPI:1568297612
Name:MOORE, REBECCA JEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JEAN
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 1:102 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-1134
Mailing Address - Country:US
Mailing Address - Phone:989-980-6148
Mailing Address - Fax:
Practice Address - Street 1:1650 STATE HIGHWAY 351
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4766
Practice Address - Country:US
Practice Address - Phone:325-677-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist