Provider Demographics
NPI:1790258507
Name:MOORE, TOLBERT JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:TOLBERT
Middle Name:JAMES
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 1:4400 TEASLEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4651
Mailing Address - Country:US
Mailing Address - Phone:940-382-1618
Mailing Address - Fax:
Practice Address - Street 1:4400 TEASLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-4651
Practice Address - Country:US
Practice Address - Phone:940-382-1618
Practice Address - Fax:940-898-1986
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist