Provider Demographics
NPI:1376990747
Name:MORISOLI, ADAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MORISOLI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CARLSBAD VILLAGE DR
Mailing Address - Street 2:#D2
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1883
Mailing Address - Country:US
Mailing Address - Phone:760-729-2405
Mailing Address - Fax:760-729-1340
Practice Address - Street 1:1005 CARLSBAD VILLAGE DR
Practice Address - Street 2:#D2
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1883
Practice Address - Country:US
Practice Address - Phone:760-729-2405
Practice Address - Fax:760-729-1340
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64365OtherPHARMACIST LICENSE NUMBER