Provider Demographics
NPI:1396169553
Name:MORESCO, ROBERT (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MORESCO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-5206
Mailing Address - Country:US
Mailing Address - Phone:262-338-1156
Mailing Address - Fax:262-338-2497
Practice Address - Street 1:1921 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5206
Practice Address - Country:US
Practice Address - Phone:262-338-1156
Practice Address - Fax:262-338-2497
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16198-40183500000X
IL051.294157183500000X
MO2013013766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist