Provider Demographics
NPI:1396959326
Name:MOORE, CRESCENT ELAYNE (PHARMD, PHD)
Entity type:Individual
Prefix:
First Name:CRESCENT
Middle Name:ELAYNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1330
Mailing Address - Country:US
Mailing Address - Phone:615-760-8767
Mailing Address - Fax:
Practice Address - Street 1:3200 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1330
Practice Address - Country:US
Practice Address - Phone:615-760-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist