Provider Demographics
NPI:1346301413
Name:MOORES PHARMACY INC
Entity Type:Organization
Organization Name:MOORES PHARMACY INC
Other - Org Name:MOORES COMPOUNDING PHARMACY
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 1:5945 MCARDLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3490
Mailing Address - Country:US
Mailing Address - Phone:361-853-2061
Mailing Address - Fax:361-853-2055
Practice Address - Street 1:5945 MCARDLE RD STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3491
Practice Address - Country:US
Practice Address - Phone:361-853-2061
Practice Address - Fax:361-853-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX232163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4537025OtherNCPDP PROVIDER IDENTIFICATION NUMBER