Provider Demographics
NPI:1437490240
Name:MOORE, LAUREN LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4353 CLINGMAN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3207
Mailing Address - Country:US
Mailing Address - Phone:318-422-4642
Mailing Address - Fax:
Practice Address - Street 1:2735 BEENE BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5491
Practice Address - Country:US
Practice Address - Phone:318-678-6801
Practice Address - Fax:318-678-6811
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist