Provider Demographics
NPI:1366008658
Name:MOORE, JILL MEREDITH (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MEREDITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1158
Mailing Address - Country:US
Mailing Address - Phone:254-967-4078
Mailing Address - Fax:
Practice Address - Street 1:604 N PATRICK ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-1122
Practice Address - Country:US
Practice Address - Phone:254-445-3679
Practice Address - Fax:254-445-2771
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist