Provider Demographics
NPI:1790253235
Name:MOORE, MELISSA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDS
Mailing Address - State:GA
Mailing Address - Zip Code:31076-2449
Mailing Address - Country:US
Mailing Address - Phone:706-442-9989
Mailing Address - Fax:
Practice Address - Street 1:510 GA HIGHWAY 247 S
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3865
Practice Address - Country:US
Practice Address - Phone:478-273-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20443183500000X
GA030533183500000X
GARPH030533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist