Individual
TRACEY L. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 W COLUMBIA ST, FARMINGTON, MO 63640-2902
(573) 218-6792
(573) 218-6762
Mailing address
302 W SYCAMORE ST, DESLOGE, MO 63601-3412
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
2000145209
MO
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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