Provider Demographics
NPI:1235241613
Name:RODNEY L MOORE
Entity Type:Organization
Organization Name:RODNEY L MOORE
Other - Org Name:MOORE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:601-625-7158
Mailing Address - Street 1:811 HIGHWAY 16 E
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4245
Mailing Address - Country:US
Mailing Address - Phone:601-267-8078
Mailing Address - Fax:601-267-6886
Practice Address - Street 1:811 HIGHWAY 16 E
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4245
Practice Address - Country:US
Practice Address - Phone:601-267-8078
Practice Address - Fax:601-267-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330261Medicaid
0576330002Medicare ID - Type Unspecified
MS00330261Medicaid