Provider Demographics
NPI:1689970451
Name:MOORE, NANCY TODD (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:TODD
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 1:5116 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1420
Mailing Address - Country:US
Mailing Address - Phone:919-471-3933
Mailing Address - Fax:919-471-6372
Practice Address - Street 1:5116 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1420
Practice Address - Country:US
Practice Address - Phone:919-471-3933
Practice Address - Fax:919-471-6372
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist