Provider Demographics
NPI:1427640374
Name:MORENO, ANDREA (CPHT 470100109020122)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:CPHT 470100109020122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 SUNSET POINT DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5404
Mailing Address - Country:US
Mailing Address - Phone:209-261-0903
Mailing Address - Fax:
Practice Address - Street 1:3000 SAUL KLEINFELD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0989
Practice Address - Country:US
Practice Address - Phone:915-849-7804
Practice Address - Fax:915-849-7807
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163977183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician