Provider Demographics
NPI:1144631334
Name:MOORE, STEVEN H
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:H
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3649 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1118
Mailing Address - Country:US
Mailing Address - Phone:217-655-7210
Mailing Address - Fax:217-655-7265
Practice Address - Street 1:3649 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1118
Practice Address - Country:US
Practice Address - Phone:217-655-7210
Practice Address - Fax:217-655-7265
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist