Provider Demographics
NPI:1851695597
Name:MORALES, ANDREA E (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:E
Last Name:MORALES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:A
Other - Last Name:AGUIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1489
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-1489
Mailing Address - Country:US
Mailing Address - Phone:201-914-5187
Mailing Address - Fax:
Practice Address - Street 1:1016A TAMARAX
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01610200183500000X
PR002262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist