Healthcare Provider Details

I. General information

NPI: 1467652305
Provider Name (Legal Business Name): LYNNE DANA MOORE PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E MAIN ST
HENDERSON TN
38340-2335
US

IV. Provider business mailing address

PO BOX 224
HENDERSON TN
38340-0224
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-2166
  • Fax: 731-989-9685
Mailing address:
  • Phone: 731-989-2166
  • Fax: 731-989-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberTN7422
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: