Provider Demographics
NPI:1407938434
Name:MOORE, WALTER H (BS PHARM)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:H
Last Name:MOORE
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 S 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4032
Mailing Address - Country:US
Mailing Address - Phone:928-782-6751
Mailing Address - Fax:
Practice Address - Street 1:1175 SHAW STREET
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85369-9116
Practice Address - Country:US
Practice Address - Phone:928-269-3177
Practice Address - Fax:928-269-0890
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist