Provider Demographics
NPI:1740368067
Name:MOORE, RANDALL ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ALAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2815 INGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-3365
Mailing Address - Country:US
Mailing Address - Phone:402-339-2959
Mailing Address - Fax:402-559-7150
Practice Address - Street 1:THE NEBRASKA MEDICAL CENTER CLINIC PHARMACY
Practice Address - Street 2:989200 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9200
Practice Address - Country:US
Practice Address - Phone:402-559-6037
Practice Address - Fax:402-559-7150
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist