Provider Demographics
NPI:1205811163
Name:MOYER, KURT ALAN (RPH)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:ALAN
Last Name:MOYER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 E 82ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1458
Mailing Address - Country:US
Mailing Address - Phone:317-842-5771
Mailing Address - Fax:317-842-5953
Practice Address - Street 1:7320 E 82ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1458
Practice Address - Country:US
Practice Address - Phone:317-842-5771
Practice Address - Fax:317-842-5953
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist