Individual
TRISHA ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-9670
Mailing address
505 N WABASH AVE, MARION, IN 46952-2608
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26022177A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26022177A
INDIANA STATE LICENSE
IN
Enumeration date
02/06/2018
Last updated
02/06/2018
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