Provider Demographics
NPI:1003106550
Name:MOORE, WILLIAM R (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
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 1:2400 N COLUMBIA ST
Mailing Address - Street 2:STE 13
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2069
Mailing Address - Country:US
Mailing Address - Phone:478-452-3589
Mailing Address - Fax:478-451-3051
Practice Address - Street 1:2400 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2069
Practice Address - Country:US
Practice Address - Phone:478-452-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist