Provider Demographics
NPI:1710588033
Name:MOON, DARLA ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:ANNE
Last Name:MOON
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 1:212 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-6331
Mailing Address - Country:US
Mailing Address - Phone:903-681-6012
Mailing Address - Fax:
Practice Address - Street 1:1405 E TYLER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-4613
Practice Address - Country:US
Practice Address - Phone:903-677-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist