Provider Demographics
NPI:1558638585
Name:MOORE, ERIKA N (PHARM D, BCPS)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:N
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARM D, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BAY BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-8106
Mailing Address - Country:US
Mailing Address - Phone:770-689-6460
Mailing Address - Fax:
Practice Address - Street 1:107 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4098
Practice Address - Country:US
Practice Address - Phone:770-371-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist