Provider Demographics
NPI:1740589977
Name:MOORE, JOHN RILEY (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RILEY
Last Name:MOORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3306
Mailing Address - Country:US
Mailing Address - Phone:615-822-4903
Mailing Address - Fax:615-822-6331
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3306
Practice Address - Country:US
Practice Address - Phone:615-822-4903
Practice Address - Fax:615-822-6331
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist