Provider Demographics
NPI:1942812367
Name:MOORE, WILLIAM RYAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RYAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 IRVIN COBB DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-0501
Mailing Address - Country:US
Mailing Address - Phone:270-444-8011
Mailing Address - Fax:270-444-6745
Practice Address - Street 1:3360 IRVIN COBB DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0501
Practice Address - Country:US
Practice Address - Phone:270-444-8011
Practice Address - Fax:270-444-6745
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist