Active NPI
Misty Moore
- Pharmacist
- Jesup, GA
National Provider Identifier
1508260407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH028165
- Practice address
- 102 S 1St St
Jesup, GA 31545-1171 - Phone
- (912) 588-1035
- Fax
- (912) 588-7015
- NPI assigned
- Oct 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH028165 | GA | Primary |
Addresses
Primary practice location
102 S 1St St
Jesup, GA 31545-1171
Mailing address
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone (912) 435-5687
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH028165 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
102 S 1st St
Jesup, GA 31545
Phone (912) 588-1035
Organizations & group practices 2
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.
-
- Pharmacy
- Jesup, GA
- NPI 1982858718
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1508260407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145641",
"telephone_number": "912-435-5687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 S 1ST ST",
"city": "JESUP",
"state": "GA",
"postal_code": "315451171",
"telephone_number": "912-588-1035",
"fax_number": "912-588-7015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MISTY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-21",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH028165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jesup, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.