Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Nicholas Antonio Moore, DOCTOROFPHARMACY

Individual provider Pharmacist · NPI 1265042691

Dr. Nicholas Antonio Moore, DOCTOROFPHARMACY is a Pharmacist in Fairview Heights, Illinois. Practices as a sole proprietor. Licensed in Arizona and Missouri.

Licensed in
AZ, MO
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

604 Cherry Dr
Fairview Heights, IL 62208-2846
Phone: (618) 409-1573
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 2016027148 (MO)
Pharmacist Taxonomy 183500000X · Licence S022386 (AZ)

Record details

NPI number1265042691
Entity typeIndividual (Type 1)
GenderMale
Credentials DOCTOROFPHARMACY
Sole proprietorYes
NPI enumeratedJuly 31, 2020
Last updated in NPPESJuly 31, 2020
Certification dateJuly 31, 2020

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