Basic Information
| Provider Information | |||||||||
| NPI: | 1457765067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3905 CONCORD PKWY S | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280279058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047066046 | ||||||||
| FaxNumber: | 7046066046 | ||||||||
| Practice Location | |||||||||
| Address1: | 3905 CONCORD PKWY S | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280279058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047066046 | ||||||||
| FaxNumber: | 7046066046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 10870 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.