Provider Demographics
NPI:1922396456
Name:MOORE, MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
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 1:2610 BISHOP DR
Mailing Address - Street 2:T-0949
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2338
Mailing Address - Country:US
Mailing Address - Phone:925-867-0245
Mailing Address - Fax:925-867-0245
Practice Address - Street 1:2610 BISHOP DR
Practice Address - Street 2:T-0949
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2338
Practice Address - Country:US
Practice Address - Phone:925-867-0245
Practice Address - Fax:925-867-0245
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55993183500000X
MD17108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist