Provider Demographics
NPI:1841221421
Name:MOORE'S PHARMACY, INC.
Entity Type:Organization
Organization Name:MOORE'S PHARMACY, INC.
Other - Org Name:MOORE'S PHARMACY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-364-1520
Mailing Address - Street 1:200 S RACHAL ST
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-2524
Mailing Address - Country:US
Mailing Address - Phone:361-364-1520
Mailing Address - Fax:361-364-4747
Practice Address - Street 1:200 S RACHAL ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2524
Practice Address - Country:US
Practice Address - Phone:361-364-1520
Practice Address - Fax:361-364-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01945333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX750667OtherBCBS-HIT
=========003OtherTRICARE DME
=========004OtherHUMANAMILITA
TX750667OtherBCBS-HIT
=========003OtherTRICARE DME