Individual
MELINDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3050 N LEWIS AVE, WAUKEGAN, IL 60087-2231
(847) 599-9079
Mailing address
2521 N AUGUSTA CT, WADSWORTH, IL 60083-8907
(262) 945-9977
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049178864
IL
Other
Enumeration date
02/11/2015
Last updated
02/11/2015
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