Individual
DR. CARLA CONNIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PD
Contact information
Practice address
4900 ROGERS AVE STE 101J, FORT SMITH, AR 72903-2068
(479) 484-9125
(479) 484-5515
Mailing address
1702 RIVER RIDGE RD, VAN BUREN, AR 72956-2084
(479) 629-4780
(479) 484-5515
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
10607
OK
183500000X
Pharmacist
Primary
PD07574
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135322407
—
AR
01
—
1467471441
NPI
—
Enumeration date
08/13/2018
Last updated
08/13/2018
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