Provider Demographics
NPI:1598883621
Name:MORALES, JOSE (992086)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:992086
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0861
Mailing Address - Country:US
Mailing Address - Phone:787-365-7306
Mailing Address - Fax:
Practice Address - Street 1:URB. BARALT
Practice Address - Street 2:CALLE1 A-8
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-365-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist