Provider Demographics
NPI:1558723551
Name:MOORE, LORI K (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
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 1:4301 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-9484
Mailing Address - Country:US
Mailing Address - Phone:785-625-0037
Mailing Address - Fax:785-625-7336
Practice Address - Street 1:4301 VINE ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-9484
Practice Address - Country:US
Practice Address - Phone:785-625-0037
Practice Address - Fax:785-625-7336
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist