Provider Demographics
NPI:1952617607
Name:MOORMAN, MARY KATHERINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:
Last Name:MOORMAN
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 1:8620 CAMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2396
Mailing Address - Country:US
Mailing Address - Phone:704-542-1584
Mailing Address - Fax:704-341-5208
Practice Address - Street 1:8620 CAMFIELD ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-542-1584
Practice Address - Fax:704-341-3831
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist