Individual
JESSICA MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
615 BULTMAN DR, SUMTER, SC 29150-2514
(803) 305-6194
(803) 305-6197
Mailing address
3755 RUCKER DR, TIMMONSVILLE, SC 29161-9224
(843) 472-1218
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
37860
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37860
SC PHARMACIST LICENSE
SC
Enumeration date
11/14/2018
Last updated
11/14/2018
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