Moore, Randall R

Moore, Randall R is an individual health care provider with primary practice located at 720 16Th Ave , Lewiston ID 83501-3768. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Moore, Randall R can be contacted via phone (208) 743-5528.

Contact Information

Primary practice address
720 16Th Ave Lewiston ID 83501-3768
Fax: (208) 746-2785
Website:

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X P3855 Idaho

Profile Details

NPI number 1669537304
LBN Legal business name Moore, Randall R
Credentials RPH
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669537304 NPPES
Idaho Other P3855 STATE LICENSE NO

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