Provider Demographics
NPI:1437613932
Name:MORELAND, GARRISON (RPH)
Entity Type:Individual
Prefix:
First Name:GARRISON
Middle Name:
Last Name:MORELAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1486
Mailing Address - Country:US
Mailing Address - Phone:217-322-3333
Mailing Address - Fax:
Practice Address - Street 1:124 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1486
Practice Address - Country:US
Practice Address - Phone:217-322-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist