Provider Demographics
NPI:1922611763
Name:MOORE, TYRRELL DASHAWN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TYRRELL
Middle Name:DASHAWN
Last Name:MOORE
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 1:254 N STATE HIGHWAY 360 APT 12302
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3134
Mailing Address - Country:US
Mailing Address - Phone:972-955-6234
Mailing Address - Fax:
Practice Address - Street 1:501 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2210
Practice Address - Country:US
Practice Address - Phone:972-291-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist