Provider Demographics
NPI:1740282961
Name:MORAN, LANCE JAY (RPH, MS)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:JAY
Last Name:MORAN
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 HIDDEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-7970
Mailing Address - Country:US
Mailing Address - Phone:608-848-5656
Mailing Address - Fax:
Practice Address - Street 1:1602 HIDDEN HILL DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-7970
Practice Address - Country:US
Practice Address - Phone:608-848-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist