Provider Demographics
NPI:1073922738
Name:MORETTA, RENAN
Entity Type:Individual
Prefix:
First Name:RENAN
Middle Name:
Last Name:MORETTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4125
Mailing Address - Country:US
Mailing Address - Phone:603-424-4833
Mailing Address - Fax:603-424-4578
Practice Address - Street 1:416 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4125
Practice Address - Country:US
Practice Address - Phone:603-424-4833
Practice Address - Fax:603-424-4578
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH3040183500000X
MAPH23465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist