Provider Demographics
NPI:1457765067
Name:MOORE, CATHY (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 CONCORD PKWY S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9058
Mailing Address - Country:US
Mailing Address - Phone:704-706-6046
Mailing Address - Fax:704-606-6046
Practice Address - Street 1:3905 CONCORD PKWY S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-9058
Practice Address - Country:US
Practice Address - Phone:704-706-6046
Practice Address - Fax:704-606-6046
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist