Provider Demographics
NPI:1942600267
Name:MOORE, RONALD EDWIN (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWIN
Last Name:MOORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13906 HOOTSELL CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2719
Mailing Address - Country:US
Mailing Address - Phone:225-241-2993
Mailing Address - Fax:800-787-7738
Practice Address - Street 1:13906 HOOTSELL CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2719
Practice Address - Country:US
Practice Address - Phone:225-241-2993
Practice Address - Fax:800-787-7738
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist