Provider Demographics
NPI:1528600541
Name:MOORE, WILLIAM BIRCH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BIRCH
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3334
Mailing Address - Country:US
Mailing Address - Phone:435-673-8898
Mailing Address - Fax:435-674-4552
Practice Address - Street 1:20 N BLUFF ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3334
Practice Address - Country:US
Practice Address - Phone:435-673-8898
Practice Address - Fax:435-674-4552
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144621-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist