Provider Demographics
NPI:1104958131
Name:BRISELLI, MONICA K (RPH, CDM)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:K
Last Name:BRISELLI
Suffix:
Gender:F
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OLD COLONY DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1059
Mailing Address - Country:US
Mailing Address - Phone:508-520-6723
Mailing Address - Fax:
Practice Address - Street 1:6 OLD COLONY DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1059
Practice Address - Country:US
Practice Address - Phone:508-478-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist