MEDICARE: MRS. LEZELLE MOOLMAN B-PHARM, M-PHARM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP444387	PA

General Provider Information

NPI Number	:	1669788774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEZELLE MOOLMAN B-PHARM, M-PHARM

Provider Business Mailing Address
First Line	:	328 FLORAL DR
Second Line	:
City	:	RED LION
State	:	PA
Zip	:	17356-8791
Country	:	US
Telephone Number	:	717-417-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W BROADWAY
Second Line	:
City	:	RED LION
State	:	PA
Zip	:	17356-1952
Country	:	US
Telephone Number	:	717-244-2919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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