Provider Demographics
NPI:1366736316
Name:MORAN, BRIAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MORAN
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 1:15527 JEANNE LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7944
Mailing Address - Country:US
Mailing Address - Phone:312-771-7783
Mailing Address - Fax:
Practice Address - Street 1:15527 JEANNE LN
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7944
Practice Address - Country:US
Practice Address - Phone:312-771-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist