Healthcare Provider Details

I. General information

NPI: 1346016276
Provider Name (Legal Business Name): MEGAN LEANN MOORE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 W MAIN PL
RUSSELLVILLE AR
72801-3398
US

IV. Provider business mailing address

17830 N STATE HIGHWAY 7
DARDANELLE AR
72834-8521
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-1323
  • Fax:
Mailing address:
  • Phone: 870-267-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16174
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: