Active NPI
Mark Anthony Eastman Moore
- Pharmacist
- Warner Robins, GA
National Provider Identifier
1851996888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH019761
- Practice address
- 802 N Houston Rd
Warner Robins, GA 31093-1502 - Phone
- (478) 923-5501
- Fax
- (478) 923-5944
- NPI assigned
- Nov 30, 2020
- Sex
- Male
- Sole proprietor
- No
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 | RPH019761 | GA | Primary |
Addresses
Primary practice location
802 N Houston Rd
Warner Robins, GA 31093-1502
Mailing address
19 Willow Lake Dr
Warner Robins
Warner Robins, GA 31093
Phone (404) 889-5600
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 |
|---|---|---|---|
| RPH019761 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1851996888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 WILLOW LAKE DR",
"address_2": "WARNER ROBINS",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "31093",
"telephone_number": "404-889-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 N HOUSTON RD",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310931502",
"telephone_number": "478-923-5501",
"fax_number": "478-923-5944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EASTMAN MOORE",
"first_name": "MARK",
"middle_name": "ANTHONY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH019761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warner Robins, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.