Provider Demographics
NPI:1932300332
Name:MORON, FEDERICO EUSEBIO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:EUSEBIO
Last Name:MORON
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 1:2601 SARAH AVE
Mailing Address - Street 2:APT 343
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8712
Mailing Address - Country:US
Mailing Address - Phone:832-529-8371
Mailing Address - Fax:956-583-2700
Practice Address - Street 1:1242 E BUSINESS HIGHWAY 83
Practice Address - Street 2:STE 7
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9310
Practice Address - Country:US
Practice Address - Phone:956-583-2700
Practice Address - Fax:956-583-2714
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5598750002Medicare ID - Type Unspecified