Individual
MR. RANDALL R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
720 16TH AVE, LEWISTON, ID 83501-3768
(208) 743-5528
(208) 746-2785
Mailing address
19054 PINE RIDGE LN, LEWISTON, ID 83501-5274
(208) 798-5293
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P3855
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P3855
STATE LICENSE NO
ID
Enumeration date
12/22/2006
Last updated
07/08/2007
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