Provider Demographics
NPI:1295109429
Name:MORENO, NATHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 FM 1765 RD
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3328
Mailing Address - Country:US
Mailing Address - Phone:281-229-4452
Mailing Address - Fax:409-938-1810
Practice Address - Street 1:1801 FM 1765 RD
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3328
Practice Address - Country:US
Practice Address - Phone:281-229-4452
Practice Address - Fax:409-938-1810
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist