Individual
JERRY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.PH
Contact information
Practice address
1902 N ACADEMY ST, GUYMON, OK 73942-2756
(580) 338-8421
(580) 338-0721
Mailing address
1902 N ACADEMY ST, GUYMON, OK 73942-2756
(580) 338-8421
(580) 338-0721
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8564
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235280A
—
OK
Enumeration date
10/19/2017
Last updated
06/16/2018
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