Individual provider Active NPI

William Ryan Moore, PHARMD, RPH

  • Pharmacist
  • Paducah, KY
National Provider Identifier
1942812367
Registry record updated Dec 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
021027 Issued in KY
Practice address
3360 Irvin Cobb Dr
Paducah, KY 42003-0501
Phone
(270) 444-8011
Fax
(270) 444-6745
NPI assigned
Aug 18, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 021027 KY Primary

Addresses

Primary practice location

3360 Irvin Cobb Dr
Paducah, KY 42003-0501

Mailing address

3360 Irvin Cobb Dr
Paducah, KY 42003-0501
Phone (270) 444-8011

Other practice location 1

1205 Main St
Murray, KY 42071-1820
Phone (270) 762-8991

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
Credentials
Doctor of Pharmacy, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
021027KYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Aug 1, 2020 Accepting new patients
Walgreen Co PastSince Jan 1, 2023 Accepting new patients
Walgreen Co PastSince Aug 1, 2020 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672012800000",
    "number": "1942812367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 IRVIN COBB DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420030501",
            "telephone_number": "270-444-8011",
            "fax_number": "270-444-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 IRVIN COBB DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420030501",
            "telephone_number": "270-444-8011",
            "fax_number": "270-444-6745"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1205 Main St",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "KY",
            "postal_code": "420711820",
            "country_code": "US",
            "telephone_number": "270-762-8991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "WILLIAM",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2022-12-26",
        "certification_date": "2022-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "021027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.

Verify at the official NPI Registry.