Provider Demographics
NPI:1386940369
Name:MOORE, LAYNE ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:ALEXANDER
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22661 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9459
Mailing Address - Country:US
Mailing Address - Phone:479-756-2678
Mailing Address - Fax:479-756-2678
Practice Address - Street 1:22661 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-9459
Practice Address - Country:US
Practice Address - Phone:479-756-2678
Practice Address - Fax:479-756-2678
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist