Provider Demographics
NPI:1952025728
Name:MORALES SIERRA, VICTOR MANUEL
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:MORALES SIERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13153 OLD HICKORY BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4990
Mailing Address - Country:US
Mailing Address - Phone:615-809-8320
Mailing Address - Fax:
Practice Address - Street 1:11563 OLD NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3525
Practice Address - Country:US
Practice Address - Phone:615-223-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist