Provider Demographics
NPI:1366650483
Name:MOORE, RONNA ANNETTE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RONNA
Middle Name:ANNETTE
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 1:161 HERITAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-9530
Mailing Address - Country:US
Mailing Address - Phone:770-228-0444
Mailing Address - Fax:
Practice Address - Street 1:161 HERITAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-9530
Practice Address - Country:US
Practice Address - Phone:770-228-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist