Provider Demographics
NPI:1437147519
Name:MOORE, JEAN K (RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:K
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 1:64 COGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2503
Mailing Address - Country:US
Mailing Address - Phone:518-561-4081
Mailing Address - Fax:
Practice Address - Street 1:28 MONTCALM AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1533
Practice Address - Country:US
Practice Address - Phone:518-563-3400
Practice Address - Fax:518-563-5946
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist