Provider Demographics
NPI:1881949618
Name:MOYER, COLLEEN M (RPH)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:MOYER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 S FORGE RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8342
Mailing Address - Country:US
Mailing Address - Phone:717-838-6461
Mailing Address - Fax:
Practice Address - Street 1:3000 CRUMS MILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-651-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032103L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist