MEDICARE: LANCE JAY MORAN R.PH., M.S.

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	11410	WI

General Provider Information

NPI Number	:	1740282961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE JAY MORAN R.PH., M.S.

Provider Business Mailing Address
First Line	:	1602 HIDDEN HILL DR
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-7970
Country	:	US
Telephone Number	:	608-848-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 HIDDEN HILL DR
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-7970
Country	:	US
Telephone Number	:	608-848-5656
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/11/2020

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