Provider Demographics
NPI:1326061284
Name:MOORE FAMILY STORES INC.
Entity Type:Organization
Organization Name:MOORE FAMILY STORES INC.
Other - Org Name:TOLEDO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-362-6226
Mailing Address - Street 1:2245 W MOUND RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9367
Mailing Address - Country:US
Mailing Address - Phone:217-362-6226
Mailing Address - Fax:217-362-6241
Practice Address - Street 1:104 COURT HOUSE SQ
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468
Practice Address - Country:US
Practice Address - Phone:217-849-2666
Practice Address - Fax:217-849-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540203303336C0003X
IL0540157663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2016686OtherPK
2016686OtherPK
0746390009Medicare NSC
2016686OtherPK
2016686OtherPK