Provider Demographics
NPI:1669089090
Name:MOORE, PATRICK (BSPHARM, PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:BSPHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5500
Mailing Address - Country:US
Mailing Address - Phone:304-918-6056
Mailing Address - Fax:304-918-6039
Practice Address - Street 1:200 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5500
Practice Address - Country:US
Practice Address - Phone:304-918-6056
Practice Address - Fax:304-918-6039
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP005844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist