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NPI Code Detail

MEDICARE: JESSICA MORENO

MEDICARE: JESSICA MORENO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist37860SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
137860OTHERSCSC PHARMACIST LICENSE

General Provider Information

NPI Number : 1164991782
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MORENO
Provider Business Mailing Address
First Line : 3755 RUCKER DR
Second Line :
City : TIMMONSVILLE
State : SC
Zip : 29161-9224
Country : US
Telephone Number : 843-472-1218
Fax Number :
Provider Business Practice Location Address
First Line : 615 BULTMAN DR
Second Line :
City : SUMTER
State : SC
Zip : 29150-2514
Country : US
Telephone Number : 803-305-6194
Fax Number : 803-305-6197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2018
Last Update Date : 11/14/2018

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Directions to “ JESSICA MORENO ” Practice Location

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