JACQUELYN MARIE MOORE (NPI# 1578819728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578819728 |
| Entity Type | Individual |
| Full Name | JACQUELYN MARIE MOORE |
| Credential | PHARM.D. |
| Practice Address |
7300 N Perimeter Rd Malmstrom Afb MT 59402-6701 |
| Practice Telephone | 4067314846 |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2015-08-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 70425 | CA | Pharmacy Service Providers |
| N | 183500000X | Pharmacist | P6746 | ID | Pharmacy Service Providers |
| N | 183500000X | Pharmacist | 18503 | NV | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | 6655 | MT | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063926194 | Jacquelyn Renea Moore | Counselor | 5665 Hoover Rd, Grove City, OH 43123-9280 | 2017-11-28 |
| Street Address |
7300 N PERIMETER RD |
| City | MALMSTROM AFB |
| State | MT |
| Zip Code | 59402-6701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205837184 | Deborah M Garrity | Pediatrics | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2005-08-02 |
| 1083220149 | Mayra Y Corona | Dental Assistant | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2020-09-23 |
| 1962012781 | Mercy Jean Padgett | Dental Hygienist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2020-08-06 |
| 1720596810 | 341 Medical Group | Clinic/Center | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2018-01-11 |
| 1801305180 | Gabriella Seraphina Darrow | Dietitian, Registered | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2017-09-29 |
| 1134642036 | Nancy M Branch | Nurse Practitioner | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2017-07-23 |
| 1649623042 | Craig Brown | Dentist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2016-07-20 |
| 1407222490 | Rachel Elder | Pharmacist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2015-08-13 |
| 1710392352 | 341st Medical Group | Pharmacy | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2014-06-23 |
| 1265862478 | Michael Rohan | Military Health Care Provider | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2013-11-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194255166 | Jonathan Tankersley | Dentist | 7300 Perimeter Rd, Malmstrom Afb, Mt 59402, Dental Clinic, Apo, AA 59402 | 2017-06-13 |
| 1780061960 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Rd., Bldg 1340, Malmstrom Afb, MT 59402 | 2015-04-27 |
| 1396181533 | 341st Medical Group | Military/U.S. Coast Guard Pharmacy | 341 Mdg/mdss/sgsa 7300 N Perimeter Rd, Bldg 2040, Malstrom Afb, MT 59402 | 2013-05-15 |
| 1205098258 | Dennis Gordon Vanhook | Social Worker | 7300 N Peirmeter Road, 341st Medical Group, Malmstrom Afb, MT 59402 | 2008-07-01 |
| 1437205119 | Misty Dawn Robertson | Dental Hygienist | 3700 N Perimeter Road, Malmstrom Afb, MT 59402 | 2007-01-26 |
| 1699738278 | Carol F Nelson | Nurse Practitioner | 7300 North Perimeter Rd, Malmstrom Afb, MT 59402 | 2006-04-06 |
| 1952541716 | Stacey Renee Vierra | Physician Assistant | 7300 North Perimeter Road, 341 Medical Group, Malmstrom Afb, MT 59402 | 2009-03-05 |
| 1306094461 | Jeremy Gustafson | Pharmacist | 7300 North Perimeter Road, Malmstrom Afb, MT 59402 | 2008-09-03 |
| 1356329817 | Timothy Paul Gacioch | Physician Assistant | 4300 Perimeter Rd, (341st Med Group) Bldg 2040, Room S156, Malmstrom Afb, MT 59402-0001 | 2006-01-05 |
| 1104848159 | Malmstrom Air Force Base | Military Hospital | 7300 N Perimeter Rd Bldg 2040, 341 Mdos/sgomhf Malmstrom Afb, Great Falls, MT 59402-6701 | 2006-07-25 |
| Find all providers in zip 59402 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407222490 | Rachel Elder | Pharmacist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2015-08-13 |
| 1396021986 | Julie Ann Ward | Pharmacist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2011-10-26 |
| 1306094461 | Jeremy Gustafson | Pharmacist | 7300 North Perimeter Road, Malmstrom Afb, MT 59402 | 2008-09-03 |
| 1942460944 | Nhien Huong Bui | Pharmacist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2008-06-12 |
| 1659477388 | Fernando Santana | Pharmacist | 7300 N Perimeter Rd, Malmstrom Afb, MT 59402-6701 | 2006-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104435916 | Christopher Ludwig | Pharmacist | 4011 Melrose Pl, Missoula, MT 59808-5890 | 2020-07-28 |
| 1932727518 | Alex Mattucci | Pharmacist | 200 South 23rd St, Bozeman, MT 59718 | 2020-07-09 |
| 1144858465 | Krystel Alene Buckland | Pharmacist | 1921 14th St W, Billings, MT 59102-3113 | 2020-03-31 |
| 1043843733 | Marissa Richie | Pharmacist | 16862 Beckwith St Ste P, Frenchtown, MT 59834-9001 | 2020-02-20 |
| 1043864218 | Gary Palladino | Pharmacist | 5050 Upper Box Elder Rd, Box Elder, MT 59521 | 2019-07-26 |
| 1053973701 | Alexander Vladimirovich Chinikaylo | Pharmacist | 10878 Peaks Row Ln, Missoula, MT 59808-8478 | 2019-07-02 |
| 1912466202 | Jenner Minto | Pharmacist | University of Montana 317 Skaggs Building, Missoula, MT 59812-0001 | 2019-03-15 |
| 1487126991 | Johnathan Watt | Pharmacist | 2086 Us Highway 93 N Ste 110, Victor, MT 59875-9209 | 2018-12-21 |
| 1255819868 | Jacob Kreamer | Pharmacist | 3195 E Custer Ave, Helena, MT 59602 | 2018-08-06 |
| 1003312224 | Ashley Grammens | Pharmacist | 307 Harmon Street, Glendive, MT 59330 | 2018-04-05 |
| Find all providers with the same taxonomy | ||||
| City | MALMSTROM AFB |
| Zip Code | 59402 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.