Provider Demographics
NPI:1780202069
Name:MORITA, HOLLY S (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:S
Last Name:MORITA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:S
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15400 W WADDELL RD UNIT 1104
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5179
Mailing Address - Country:US
Mailing Address - Phone:808-651-7560
Mailing Address - Fax:
Practice Address - Street 1:8990 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1127
Practice Address - Country:US
Practice Address - Phone:855-250-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist