Provider Demographics
NPI:1356956643
Name:MOORMAN, GARRETT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19885 215TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-9021
Mailing Address - Country:US
Mailing Address - Phone:641-895-7681
Mailing Address - Fax:
Practice Address - Street 1:2929 WESTOWN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1319
Practice Address - Country:US
Practice Address - Phone:641-895-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist