Provider Demographics
NPI:1801979307
Name:MORAN, LYNN A (RPH)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:MORAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 BROOKMEADE CIR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9085
Mailing Address - Country:US
Mailing Address - Phone:614-371-2626
Mailing Address - Fax:614-875-9862
Practice Address - Street 1:6229 BROOKMEADE CIR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9085
Practice Address - Country:US
Practice Address - Phone:614-371-2626
Practice Address - Fax:614-875-9862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-13469183500000X
PARP027744L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist