Provider Demographics
NPI:1457684706
Name:MOORE, LEWIS CURRIE JR (DPH)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:CURRIE
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2050
Mailing Address - Country:US
Mailing Address - Phone:615-446-7485
Mailing Address - Fax:
Practice Address - Street 1:301 HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2050
Practice Address - Country:US
Practice Address - Phone:615-446-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist