Organization
MOORE HEALTHCARE, INC.
Active
Other names
PALACE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY P MOORE (MANAGER)
(918) 358-2587
Entity
Organization
Contact information
Practice address
301 N BROADWAY ST, CLEVELAND, OK 74020-3421
(918) 358-2524
(918) 358-2588
Mailing address
301 N BROADWAY ST, CLEVELAND, OK 74020-3421
(918) 358-2524
(918) 358-2588
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
OK
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
52-4094
OK
332BX2000X
Oxygen Equipment & Supplies (DME)
52-S-1138
OK
3336C0003X
Community/Retail Pharmacy
52-4094
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100811860
—
OK
05
—
100811860A
—
OK
05
—
100811860B
—
OK
01
—
3700499
PHARMACY NCPDP NUMBER
OK
Enumeration date
01/22/2007
Last updated
02/07/2022
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