Provider Demographics
NPI:1932170883
Name:BRISKI, THEODORE PHILLIP JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:PHILLIP
Last Name:BRISKI
Suffix:JR
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 1:2800 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-4937
Mailing Address - Country:US
Mailing Address - Phone:760-745-7608
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DRIVE
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-6113
Practice Address - Country:US
Practice Address - Phone:619-532-5078
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy