Provider Demographics
NPI:1114962594
Name:MOORE'S PHARMACY INC.
Entity Type:Organization
Organization Name:MOORE'S PHARMACY INC.
Other - Org Name:MOORE'S PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELBY
Authorized Official - Middle Name:DAIN
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-853-2061
Mailing Address - Street 1:200 S RACHAL ST
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-2524
Mailing Address - Country:US
Mailing Address - Phone:361-364-1416
Mailing Address - Fax:361-364-5028
Practice Address - Street 1:200 S RACHAL ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2524
Practice Address - Country:US
Practice Address - Phone:361-364-1416
Practice Address - Fax:361-364-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01945332B00000X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1209926-02Medicaid
TX1209926-01Medicaid
TX750667OtherBCBS - HIT
TX1209926-04Medicaid
=========004OtherTRICARE HIT
TX1209926-04Medicaid
TX1209926-01Medicaid
TX1209926-01Medicaid