Provider Demographics
NPI:1487471447
Name:MOON, MICHELLE APRIL (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:APRIL
Last Name:MOON
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 1:2423 NORTHGATE ST APT 23
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1174
Mailing Address - Country:US
Mailing Address - Phone:319-450-9226
Mailing Address - Fax:
Practice Address - Street 1:1025 N QUINCY AVE STE 2
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3874
Practice Address - Country:US
Practice Address - Phone:641-683-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist