Provider Demographics
NPI:1154951622
Name:MOELLER, ADAM LAMONT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LAMONT
Last Name:MOELLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2294
Mailing Address - Country:US
Mailing Address - Phone:801-653-2709
Mailing Address - Fax:801-653-2706
Practice Address - Street 1:198 N 1200 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2294
Practice Address - Country:US
Practice Address - Phone:801-653-2709
Practice Address - Fax:801-653-2706
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10921906-17033336C0003X
UT7475454-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7475454-1701OtherUTAH STATE BOARD PHARMACIST LICENSE
UT7475454-1701OtherUTAH STATE BOARD PHARMACIST LICENSE