Provider Demographics
NPI:1942720636
Name:LOONEY, LISA MOORE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MOORE
Last Name:LOONEY
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 1:1808 CATALA RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1708
Mailing Address - Country:US
Mailing Address - Phone:205-529-7002
Mailing Address - Fax:
Practice Address - Street 1:1300 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2702
Practice Address - Country:US
Practice Address - Phone:205-822-6022
Practice Address - Fax:205-822-3640
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist