Provider Demographics
NPI:1790017036
Name:MORESCO, DENNIS MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MORESCO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 EAGLE PT
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8356
Mailing Address - Country:US
Mailing Address - Phone:815-877-0368
Mailing Address - Fax:
Practice Address - Street 1:5909 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2429
Practice Address - Country:US
Practice Address - Phone:815-229-5719
Practice Address - Fax:815-229-0013
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist