Healthcare Provider Details

I. General information

NPI: 1245830819
Provider Name (Legal Business Name): RACHEL ERIN MOORMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINCOLN AVE
BEARDSTOWN IL
62618-9301
US

IV. Provider business mailing address

100 LINCOLN AVE
BEARDSTOWN IL
62618-9301
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-1327
  • Fax: 217-323-1329
Mailing address:
  • Phone: 217-323-1327
  • Fax: 217-323-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051287249
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: