Healthcare Provider Details

I. General information

NPI: 1255915005
Provider Name (Legal Business Name): LUIS NORBERTO MORENO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N 1460 W
SALT LAKE CITY UT
84116-3231
US

IV. Provider business mailing address

288 N 1460 W
SALT LAKE CITY UT
84116-3231
US

V. Phone/Fax

Practice location:
  • Phone: 801-538-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7177351-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: