Healthcare Provider Details

I. General information

NPI: 1730785742
Provider Name (Legal Business Name): MARLENE BERNADETTE MORANO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901C BUSTLETON AVE
PHILADELPHIA PA
19116-3305
US

IV. Provider business mailing address

1308 BRIGHTON ST
PHILADELPHIA PA
19111-4247
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-2122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033078L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: