Provider Demographics
NPI:1841941341
Name:MOORE, CHRISTA WALDROP (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:WALDROP
Last Name:MOORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:CHRISTA
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:135 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1914
Mailing Address - Country:US
Mailing Address - Phone:662-489-3171
Mailing Address - Fax:662-489-3172
Practice Address - Street 1:135 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1914
Practice Address - Country:US
Practice Address - Phone:662-489-3171
Practice Address - Fax:662-489-3172
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist