Provider Demographics
NPI:1962784348
Name:MOORE, TAMARA Y (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:Y
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-3109
Mailing Address - Country:US
Mailing Address - Phone:319-390-9925
Mailing Address - Fax:319-390-9943
Practice Address - Street 1:3601 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3109
Practice Address - Country:US
Practice Address - Phone:319-390-9925
Practice Address - Fax:573-875-1097
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024154183500000X
IA24114183500000X
OH03127283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24114OtherIOWA BOARD OF PHARMACY