Provider Demographics
NPI:1548085244
Name:MOORE, STEVEN J (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1779
Mailing Address - Country:US
Mailing Address - Phone:203-252-1527
Mailing Address - Fax:
Practice Address - Street 1:45 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2447
Practice Address - Country:US
Practice Address - Phone:860-613-0741
Practice Address - Fax:860-613-9912
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0005786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist