MEDICARE: MR. SIEGFRED MORENO RPH

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
1	183500000X	Pharmacist	PS0014581	FL
2	183500000X	Pharmacist	6380	NV

General Provider Information

NPI Number	:	1396186870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIEGFRED MORENO RPH

Provider Business Mailing Address
First Line	:	979 HUNTING LODGE DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	979 HUNTING LODGE DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5751
Country	:	US
Telephone Number	:	305-888-2794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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