Provider Demographics
NPI:1225265036
Name:MOORMAN, DEBRA PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:PAUL
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4564
Mailing Address - Country:US
Mailing Address - Phone:630-809-5654
Mailing Address - Fax:630-378-4331
Practice Address - Street 1:217 SPARROW LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4564
Practice Address - Country:US
Practice Address - Phone:630-809-5654
Practice Address - Fax:630-378-4331
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510390841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy