Individual
CASEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
167 MAIN ST, TUBA CITY, AZ 86045-0600
(928) 283-2754
Mailing address
PO BOX 3460, TUBA CITY, AZ 86045-3460
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03439210
OH
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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