Provider Demographics
NPI:1992806749
Name:MORALES, LISSETTE H (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:H
Last Name:MORALES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 NW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2329
Mailing Address - Country:US
Mailing Address - Phone:305-559-2993
Mailing Address - Fax:
Practice Address - Street 1:11241 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4467
Practice Address - Country:US
Practice Address - Phone:305-559-5285
Practice Address - Fax:305-551-5630
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0036221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist