Provider Demographics
NPI:1942294509
Name:DONALD D MOORE PHARMACY INC
Entity Type:Organization
Organization Name:DONALD D MOORE PHARMACY INC
Other - Org Name:MOORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-921-0020
Mailing Address - Street 1:4486 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4926
Mailing Address - Country:US
Mailing Address - Phone:513-921-0020
Mailing Address - Fax:513-921-4448
Practice Address - Street 1:4486 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4926
Practice Address - Country:US
Practice Address - Phone:513-921-0020
Practice Address - Fax:513-921-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0491132332B00000X
OH020186100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0491132Medicaid
OH0491132Medicaid
OH0796770001Medicare NSC