Provider Demographics
NPI:1902290703
Name:MORELLI, MATTHEW DOMINIC I (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DOMINIC
Last Name:MORELLI
Suffix:I
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 1:801 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4424
Mailing Address - Country:US
Mailing Address - Phone:352-629-6188
Mailing Address - Fax:
Practice Address - Street 1:801 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4424
Practice Address - Country:US
Practice Address - Phone:352-629-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist