Provider Demographics
NPI:1669788774
Name:MOOLMAN, LEZELLE (B-PHARM, M-PHARM)
Entity type:Individual
Prefix:MRS
First Name:LEZELLE
Middle Name:
Last Name:MOOLMAN
Suffix:
Gender:F
Credentials:B-PHARM, M-PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-8791
Mailing Address - Country:US
Mailing Address - Phone:717-417-6146
Mailing Address - Fax:
Practice Address - Street 1:910 W BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-1952
Practice Address - Country:US
Practice Address - Phone:717-244-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist