Provider Demographics
NPI:1154677433
Name:MORENO, ALFREDO C (BS)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:C
Last Name:MORENO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 W 4TH AVE
Mailing Address - Street 2:STE 1-6
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6606
Mailing Address - Country:US
Mailing Address - Phone:305-557-3151
Mailing Address - Fax:305-557-8239
Practice Address - Street 1:6500 W 4TH AVE
Practice Address - Street 2:STE 1-6
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6606
Practice Address - Country:US
Practice Address - Phone:305-557-3151
Practice Address - Fax:305-557-8239
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0016906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist