Healthcare Provider Details

I. General information

NPI: 1073922738
Provider Name (Legal Business Name): RENAN MORETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 DANIEL WEBSTER HWY
MERRIMACK NH
03054-4125
US

IV. Provider business mailing address

416 DANIEL WEBSTER HWY
MERRIMACK NH
03054-4125
US

V. Phone/Fax

Practice location:
  • Phone: 603-424-4833
  • Fax: 603-424-4578
Mailing address:
  • Phone: 603-424-4833
  • Fax: 603-424-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNH3040
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH23465
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: