Provider Demographics
NPI:1346016276
Name:MOORE, MEGAN LEANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEANN
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 1:17830 N STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-8521
Mailing Address - Country:US
Mailing Address - Phone:870-267-4955
Mailing Address - Fax:
Practice Address - Street 1:3103 W MAIN PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3398
Practice Address - Country:US
Practice Address - Phone:479-968-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist