Provider Demographics
NPI:1790425791
Name:MOORE, JAIMIE CLARICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAIMIE
Middle Name:CLARICE
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 1:427 E FM 1382
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6006
Mailing Address - Country:US
Mailing Address - Phone:972-291-0241
Mailing Address - Fax:
Practice Address - Street 1:427 E FM 1382
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6006
Practice Address - Country:US
Practice Address - Phone:972-291-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist