Provider Demographics
NPI:1114552213
Name:MOORE, TONI GARNER (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:GARNER
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SPRING FANCY LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5233
Mailing Address - Country:US
Mailing Address - Phone:704-821-4205
Mailing Address - Fax:
Practice Address - Street 1:901 S 5TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5739
Practice Address - Country:US
Practice Address - Phone:843-332-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15572OtherBOARD OF PHARMACY
SC8714OtherBOARD OF PHARMACY