Provider Demographics
NPI:1346687027
Name:MOORE, KATEY MICHELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATEY
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CONVENT PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4211
Mailing Address - Country:US
Mailing Address - Phone:615-498-9583
Mailing Address - Fax:
Practice Address - Street 1:2201 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4906
Practice Address - Country:US
Practice Address - Phone:615-269-6641
Practice Address - Fax:615-269-6752
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist