Provider Demographics
NPI:1992257539
Name:MOORE, ALLEN MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21973 N 102ND LN LOT 411
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2693
Mailing Address - Country:US
Mailing Address - Phone:623-866-8684
Mailing Address - Fax:
Practice Address - Street 1:10727 W. OLIVE AVE.
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363
Practice Address - Country:US
Practice Address - Phone:623-815-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist