Provider Demographics
NPI:1053543322
Name:MOORE, ROBERT CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:MOORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17452 KAHILTNA DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8127
Mailing Address - Country:US
Mailing Address - Phone:907-240-2215
Mailing Address - Fax:
Practice Address - Street 1:17452 KAHILTNA DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8127
Practice Address - Country:US
Practice Address - Phone:907-240-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist