Provider Demographics
NPI:1114252590
Name:MOORE, URUNDI T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:URUNDI
Middle Name:T
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 1:200 HAWTHORNE LN STE T1578
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2515
Mailing Address - Country:US
Mailing Address - Phone:704-712-9260
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE LN STE T1578
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-9065
Practice Address - Fax:980-465-5175
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0607556Medicaid
NC0905496Medicaid
NC0282934156Medicare PIN