Provider Demographics
NPI:1558058578
Name:MOORE, LAWRENCE CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CHRISTOPHER
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 E DALEY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8299
Mailing Address - Country:US
Mailing Address - Phone:760-877-7437
Mailing Address - Fax:
Practice Address - Street 1:485 N JUNIPER DR STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2543
Practice Address - Country:US
Practice Address - Phone:602-366-6904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist