Healthcare Provider Details

I. General information

NPI: 1063630952
Provider Name (Legal Business Name): LISA HAMILTON MOORE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 E FRANKLIN BLVD
GASTONIA NC
28056-6297
US

IV. Provider business mailing address

8508 VAN CT
DENVER NC
28037-7783
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-0121
  • Fax: 704-866-8259
Mailing address:
  • Phone: 704-866-0121
  • Fax: 704-866-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12312
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: