Healthcare Provider Details

I. General information

NPI: 1508777475
Provider Name (Legal Business Name): LISA C MOORE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 S BROADWAY
LITTLETON CO
80122-2602
US

IV. Provider business mailing address

6699 PONDEROSA DR
PARKER CO
80138-3855
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-5822
  • Fax:
Mailing address:
  • Phone: 303-932-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14946
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: