Provider Demographics
NPI:1255867719
Name:MOORE, CAROLINE GODWIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GODWIN
Last Name:MOORE
Suffix:
Gender:F
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:PO BOX 550
Mailing Address - Street 2:120 EAST PINE STREET
Mailing Address - City:PINE LEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:27568
Mailing Address - Country:US
Mailing Address - Phone:919-616-9717
Mailing Address - Fax:
Practice Address - Street 1:1255 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4229
Practice Address - Country:US
Practice Address - Phone:919-616-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist