1740368067 NPI number — DR. RANDALL ALAN MOORE PHARM.D

Table of content: DR. RANDALL ALAN MOORE PHARM.D (NPI 1740368067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740368067 NPI number — DR. RANDALL ALAN MOORE PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
RANDALL
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740368067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2815 INGLEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68133-3365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-339-2959
Provider Business Mailing Address Fax Number:
402-559-7150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE NEBRASKA MEDICAL CENTER CLINIC PHARMACY
Provider Second Line Business Practice Location Address:
989200 NEBRASKA MEDICAL CENTER
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68198-9200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-559-6037
Provider Business Practice Location Address Fax Number:
402-559-7150
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  10943 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)