Provider Demographics
NPI:1417491259
Name:MOORE, CINDY LANE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LANE
Last Name:MOORE
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 1:308 PINEY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7937
Mailing Address - Country:US
Mailing Address - Phone:318-272-6545
Mailing Address - Fax:
Practice Address - Street 1:308 PINEY FOREST DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7937
Practice Address - Country:US
Practice Address - Phone:318-272-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist