Healthcare Provider Details

I. General information

NPI: 1952653883
Provider Name (Legal Business Name): MARIBETH TECSON MORAN PHARMD, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIBETH PENEQUITO TECSON PHARMD, BCACP

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6946 DENIO ISLAND ST
NORTH LAS VEGAS NV
89084-4029
US

IV. Provider business mailing address

6946 DENIO ISLAND ST
NORTH LAS VEGAS NV
89084-4029
US

V. Phone/Fax

Practice location:
  • Phone: 702-812-8423
  • Fax:
Mailing address:
  • Phone: 702-812-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67934
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number20913
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: