Provider Demographics
NPI:1891592101
Name:MOORE, DRAX JAMES (RPH)
Entity type:Individual
Prefix:
First Name:DRAX
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 PINTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-6416
Mailing Address - Country:US
Mailing Address - Phone:765-610-7346
Mailing Address - Fax:
Practice Address - Street 1:8375 E 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1014
Practice Address - Country:US
Practice Address - Phone:317-585-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030774A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist