Provider Demographics
NPI:1043558661
Name:MOORE, KATIE BOZEMAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:BOZEMAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 BELLS FERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7140
Mailing Address - Country:US
Mailing Address - Phone:770-516-0686
Mailing Address - Fax:770-516-6035
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-516-0686
Practice Address - Fax:770-516-6035
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist