Provider Demographics
NPI:1568185692
Name:MORAN, AUSTIN THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:THOMAS
Last Name:MORAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SOUTH STREET
Mailing Address - Street 2:APT 302
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901
Mailing Address - Country:US
Mailing Address - Phone:219-798-8857
Mailing Address - Fax:
Practice Address - Street 1:1801 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2962
Practice Address - Country:US
Practice Address - Phone:765-448-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCV2201308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist