Provider Demographics
NPI:1063630952
Name:MOORE, LISA HAMILTON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:HAMILTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 TREBOR WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0000
Mailing Address - Country:US
Mailing Address - Phone:704-263-0810
Mailing Address - Fax:
Practice Address - Street 1:110 E DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2051
Practice Address - Country:US
Practice Address - Phone:704-263-0810
Practice Address - Fax:704-263-1222
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist