Provider Demographics
NPI:1497049704
Name:MOORE, RICHARD WINFIELD III (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WINFIELD
Last Name:MOORE
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41800 WASHINGTON ST STE 113B
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-8153
Mailing Address - Country:US
Mailing Address - Phone:760-360-6280
Mailing Address - Fax:
Practice Address - Street 1:41800 WASHINGTON ST STE 113B
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-8153
Practice Address - Country:US
Practice Address - Phone:760-360-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist