Provider Demographics
NPI:1447861505
Name:MORELAND, GARRETT (PHARMD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:MORELAND
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 1:2500 W MOSS AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-5450
Mailing Address - Country:US
Mailing Address - Phone:270-366-6056
Mailing Address - Fax:
Practice Address - Street 1:2490 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2123
Practice Address - Country:US
Practice Address - Phone:502-454-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303150183500000X
IN26028594A183500000X
KY021013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist