Provider Demographics
NPI:1366047466
Name:MOORE, NATHANIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3340 S WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3242
Mailing Address - Country:US
Mailing Address - Phone:806-358-3388
Mailing Address - Fax:
Practice Address - Street 1:3340 S WESTERN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3242
Practice Address - Country:US
Practice Address - Phone:806-358-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist