Provider Demographics
NPI:1952653883
Name:MORAN, MARIBETH TECSON (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:TECSON
Last Name:MORAN
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:PENEQUITO
Other - Last Name:TECSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCACP
Mailing Address - Street 1:6946 DENIO ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4029
Mailing Address - Country:US
Mailing Address - Phone:702-812-8423
Mailing Address - Fax:
Practice Address - Street 1:6946 DENIO ISLAND ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4029
Practice Address - Country:US
Practice Address - Phone:702-812-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV209131835P2201X
CA67934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care