Individual
BRYAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 W SHOWALTER DR, GEORGETOWN, KY 40324-2081
(502) 868-6101
Mailing address
159 CHEROKEE DR, WINCHESTER, KY 40391-9500
(859) 333-5069
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012715
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012715
LICENSE
KY
Enumeration date
12/02/2020
Last updated
12/02/2020
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