Kim Ann Moore
Individual provider Active NPI Pharmacist · Spring Lake, NJ
NPI 1801064423 · NPPES record last updated Oct 31, 2013
Key facts
- NPI
- 1801064423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28RI02876300 (NJ)
- Practice address
- 2006 Hwy 35
Spring Lake, NJ 07762-2543 - Phone
- (732) 282-0719
- Fax
- (732) 282-9069
- NPI assigned
- Feb 17, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI02876300 | NJ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 040519 | NY | |
| Pharmacist | 183500000X | 28RI02876300 | NJ | Yes |
Addresses
Primary practice location
2006 Hwy 35
Spring Lake, NJ 07762-2543
Mailing address
54 Overlook Dr
Jackson, NJ 08527-4849
Phone (732) 833-7326
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040519 | Medicaid | NY |
Other providers in Spring Lake, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.