Provider Demographics
NPI:1730407727
Name:MOORE, ELISABETH MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:MARIE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7212 HOLMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7508
Mailing Address - Country:US
Mailing Address - Phone:910-865-1242
Mailing Address - Fax:910-865-1590
Practice Address - Street 1:419 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1537
Practice Address - Country:US
Practice Address - Phone:910-865-1242
Practice Address - Fax:910-865-1590
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist