Provider Demographics
NPI:1023148350
Name:MORALES, NANNETTE
Entity type:Individual
Prefix:MRS
First Name:NANNETTE
Middle Name:
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:URB JAIME C RODRIGUEZ
Mailing Address - Street 2:CALLE 11A4
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-400-3405
Mailing Address - Fax:787-893-3376
Practice Address - Street 1:CALLE SATURNINO RODRIGUEZ
Practice Address - Street 2:#30
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-4455
Practice Address - Fax:787-893-3376
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4949183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician