Organization
MOORE FAMILY STORES INC.
Active
Other names
Martinsville Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT MOORE (OWNER/PRESIDENT)
(217) 362-6226
Entity
Organization
Contact information
Practice address
890 E RIDGELAWN RD, MARTINSVILLE, IL 62442-2551
(217) 382-4004
(217) 382-3476
Mailing address
2245 W MOUND RD, DECATUR, IL 62526-9367
(217) 362-6226
(217) 362-6241
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054020327
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136610
PK
—
Enumeration date
10/26/2006
Last updated
06/02/2022
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