MEDICARE: BLANCA V MORALES RPH, CPH

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	1835G0303X	Geriatric Pharmacist	PU4803	FL

General Provider Information

NPI Number	:	1932255460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA V MORALES RPH, CPH

Provider Business Mailing Address
First Line	:	17021 N BAY RD APT 806
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4235
Country	:	US
Telephone Number	:	305-527-2675
Fax Number	:

Provider Business Practice Location Address
First Line	:	17021 N BAY RD APT 806
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-4235
Country	:	US
Telephone Number	:	305-527-2675
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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