Provider Demographics
NPI:1710271580
Name:MORELLI JR, DOMINIC VICTOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:VICTOR
Last Name:MORELLI JR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 STATE ROAD 54
Mailing Address - Street 2:T2209
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3720
Mailing Address - Country:US
Mailing Address - Phone:813-383-0011
Mailing Address - Fax:813-383-0011
Practice Address - Street 1:16400 STATE ROAD 54
Practice Address - Street 2:T2209
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3720
Practice Address - Country:US
Practice Address - Phone:813-383-0011
Practice Address - Fax:813-383-0011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist