Provider Demographics
NPI:1720353790
Name:MOORE, DANIEL KENT (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KENT
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 US HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:KY
Mailing Address - Zip Code:40347-9774
Mailing Address - Country:US
Mailing Address - Phone:859-753-0087
Mailing Address - Fax:
Practice Address - Street 1:1300 US HIGHWAY 127 S
Practice Address - Street 2:STE E
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4395
Practice Address - Country:US
Practice Address - Phone:502-223-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist