Provider Demographics
NPI:1902840069
Name:MOORE, ANN E (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
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 1:3140 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-9381
Mailing Address - Country:US
Mailing Address - Phone:920-232-8336
Mailing Address - Fax:920-787-6945
Practice Address - Street 1:900 E. DIVISON ST
Practice Address - Street 2:AURORA PHARMACY #300
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982
Practice Address - Country:US
Practice Address - Phone:920-787-6940
Practice Address - Fax:920-787-6945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9927-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist