MEDICARE: MRS. MINERVA MORALES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2045	PR

General Provider Information

NPI Number	:	1740382076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINERVA MORALES RPH

Provider Business Mailing Address
First Line	:	680 CALLE AGUAS CALIENTES
Second Line	:	VENUS GARDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4617
Country	:	US
Telephone Number	:	787-755-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 CALLE AGUAS CALIENTES
Second Line	:	VENUS GARDENS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4617
Country	:	US
Telephone Number	:	787-755-3366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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