Provider Demographics
NPI:1700168622
Name:MOORE, JOE T (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:T
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 1:901 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2309
Mailing Address - Country:US
Mailing Address - Phone:859-881-8203
Mailing Address - Fax:859-881-5652
Practice Address - Street 1:901 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2309
Practice Address - Country:US
Practice Address - Phone:859-881-8203
Practice Address - Fax:859-881-5652
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist