Provider Demographics
NPI:1558647974
Name:MOORMAN, TERRI LYNNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNNE
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2103 VETERANS BLVD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-7502
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:303-398-2879
Practice Address - Street 1:2103 VETERANS BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-7502
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:303-398-2879
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist