Healthcare Provider Details

I. General information

NPI: 1336073154
Provider Name (Legal Business Name): DAVID ANDRES MORALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9602 4TH AVE APT 4F
BROOKLYN NY
11209-7819
US

IV. Provider business mailing address

9602 4TH AVE APT 4F
BROOKLYN NY
11209-7819
US

V. Phone/Fax

Practice location:
  • Phone: 909-635-4055
  • Fax:
Mailing address:
  • Phone: 909-635-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071919-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: