Carla Connie Moore, PD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD07574 Issued in AR

Practice address

4900 Rogers Ave Ste 101J
Fort Smith, AR 72903-2068

Phone

(479) 484-9125

Fax

(479) 484-5515

NPI assigned

Aug 13, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walmart Inc.

  • Community/Retail Pharmacy
  • Fort Smith, AR
  • NPI 1467471441
  NPD (past)
• Walmart Inc.

  • Community/Retail Pharmacy
  • Eastvale, CA
  • NPI 1770458945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1184103806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 RIVER RIDGE RD",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729562084",
            "telephone_number": "479-629-4780",
            "fax_number": "479-484-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 ROGERS AVE STE 101J",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729032068",
            "telephone_number": "479-484-9125",
            "fax_number": "479-484-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CARLA",
        "middle_name": "CONNIE",
        "name_prefix": "Dr.",
        "credential": "PD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "10607",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD07574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135322407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1467471441",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Mooneyham
• Moore Dental Care
• Laura G Moore-Farrell, M.D.
• Alex McArthur Moore, PHARMD
• Brittany Moore, PTA
• Cindy B Moore, RN
• Cynthia Moore, PEER SUPPORT, QBHP
• Desiray Moore
• Jordan Moore, QBHP
• Julie Rae Moore, LCSW

• Pharmacist in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Pharmacist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.