Provider Demographics
NPI:1073502423
Name:MOORE, RANDY N (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:N
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:PO BOX 727
Mailing Address - City:MARGARETVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12455-0727
Mailing Address - Country:US
Mailing Address - Phone:845-586-2631
Mailing Address - Fax:845-586-2631
Practice Address - Street 1:RT 28
Practice Address - Street 2:RT 28
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455
Practice Address - Country:US
Practice Address - Phone:845-586-2631
Practice Address - Fax:845-586-2631
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY36561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist