Provider Demographics
NPI:1194023820
Name:MOORE, ADAM RHETT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RHETT
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 1:2704 N OAK ST BLDG B1
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1771
Mailing Address - Country:US
Mailing Address - Phone:229-244-5353
Mailing Address - Fax:229-244-5357
Practice Address - Street 1:2704 N OAK ST BLDG B1
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-244-5353
Practice Address - Fax:229-244-5357
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist