Provider Demographics
NPI:1689919375
Name:MOORMAN, OFELIA SYLVIA (RPH)
Entity Type:Individual
Prefix:
First Name:OFELIA
Middle Name:SYLVIA
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:OFELIA
Other - Middle Name:SYLVIA
Other - Last Name:MOORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:8004 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-9012
Mailing Address - Country:US
Mailing Address - Phone:210-723-4558
Mailing Address - Fax:
Practice Address - Street 1:15330 IH 35 N
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3814
Practice Address - Country:US
Practice Address - Phone:210-332-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist