Provider Demographics
NPI:1013123561
Name:MOORE, THOMAS MARION (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARION
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 1:4305 PENINSULA POINTE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0520
Mailing Address - Country:US
Mailing Address - Phone:252-752-8212
Mailing Address - Fax:
Practice Address - Street 1:4305 PENINSULA PT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0520
Practice Address - Country:US
Practice Address - Phone:252-752-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist