MEDICARE: MARIBETH TECSON MORAN PHARMD, BCACP

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	1835P2201X	Ambulatory Care Pharmacist	20913	NV
2	183500000X	Pharmacist	67934	CA

General Provider Information

NPI Number	:	1952653883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBETH TECSON MORAN PHARMD, BCACP

Provider Business Mailing Address
First Line	:	6946 DENIO ISLAND ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4029
Country	:	US
Telephone Number	:	702-812-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	6946 DENIO ISLAND ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-4029
Country	:	US
Telephone Number	:	702-812-8423
Fax Number	:

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	11/06/2023

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