Provider Demographics
NPI:1942558200
Name:MOORE, LEILA DIONE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:DIONE
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 1:242 N AVALON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5102
Mailing Address - Country:US
Mailing Address - Phone:901-672-7007
Mailing Address - Fax:
Practice Address - Street 1:950 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-1703
Practice Address - Country:US
Practice Address - Phone:901-475-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist