Provider Demographics
NPI:1396901898
Name:MORELAND, DESIREE DAWN (PHARMD, RP)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:DAWN
Last Name:MORELAND
Suffix:
Gender:F
Credentials:PHARMD, RP
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:DAWN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RP
Mailing Address - Street 1:825 CENTENNIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337
Mailing Address - Country:US
Mailing Address - Phone:308-432-0244
Mailing Address - Fax:308-432-0245
Practice Address - Street 1:825 CENTENNIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337
Practice Address - Country:US
Practice Address - Phone:308-432-0244
Practice Address - Fax:308-432-0245
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist