Provider Demographics
NPI:1902935224
Name:MOORE, HEATHER LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:MOORE
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 1:2512 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9684
Mailing Address - Country:US
Mailing Address - Phone:740-397-5574
Mailing Address - Fax:740-397-5070
Practice Address - Street 1:4 NEWARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4113
Practice Address - Country:US
Practice Address - Phone:740-393-2822
Practice Address - Fax:740-393-2837
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist