Provider Demographics
NPI:1215221379
Name:DE CASTRO-MORRIS, THERESA F
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:F
Last Name:DE CASTRO-MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 HAGEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3758
Mailing Address - Country:US
Mailing Address - Phone:561-536-0262
Mailing Address - Fax:561-536-0262
Practice Address - Street 1:10201 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3758
Practice Address - Country:US
Practice Address - Phone:561-536-0262
Practice Address - Fax:561-536-0262
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist