Provider Demographics
NPI:1619676236
Name:MORALES, ANASTASIA NATALIE
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:NATALIE
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:OH
Mailing Address - Zip Code:44044-1257
Mailing Address - Country:US
Mailing Address - Phone:440-926-2126
Mailing Address - Fax:440-926-8506
Practice Address - Street 1:479 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1257
Practice Address - Country:US
Practice Address - Phone:440-926-2126
Practice Address - Fax:440-926-8506
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09214735183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician