Provider Demographics
NPI:1659515781
Name:SORCI, MICHAEL ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:SORCI
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 1:15714 LOS GATOS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2504
Mailing Address - Country:US
Mailing Address - Phone:408-391-8806
Mailing Address - Fax:408-374-6550
Practice Address - Street 1:15714 LOS GATOS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2504
Practice Address - Country:US
Practice Address - Phone:408-391-8806
Practice Address - Fax:408-374-6550
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist