Provider Demographics
NPI:1841611480
Name:MOORE, ALICE (RPH)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1606
Mailing Address - Country:US
Mailing Address - Phone:706-867-4325
Mailing Address - Fax:706-867-4327
Practice Address - Street 1:227 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1606
Practice Address - Country:US
Practice Address - Phone:706-867-4325
Practice Address - Fax:706-867-4327
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist