Provider Demographics
NPI:1992085492
Name:MOORE, JOHN D SR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:MOORE
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3129
Mailing Address - Country:US
Mailing Address - Phone:321-638-2482
Mailing Address - Fax:321-638-2237
Practice Address - Street 1:925 BARTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3129
Practice Address - Country:US
Practice Address - Phone:321-638-2482
Practice Address - Fax:321-638-2237
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0016410183500000X
NC06814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist