Provider Demographics
NPI:1912378654
Name:MOORE, SYLVIA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30802 COAST HWY
Mailing Address - Street 2:SPC D8
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4207
Mailing Address - Country:US
Mailing Address - Phone:949-235-0343
Mailing Address - Fax:
Practice Address - Street 1:2903 SATURN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6259
Practice Address - Country:US
Practice Address - Phone:714-579-1636
Practice Address - Fax:714-579-1682
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 22225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist