Healthcare Provider Details

I. General information

NPI: 1932170883
Provider Name (Legal Business Name): THEODORE PHILLIP BRISKI JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DRIVE SUITE 113
SAN DIEGO CA
92134-6113
US

IV. Provider business mailing address

2800 MOUNTAIN VIEW DR
ESCONDIDO CA
92027-4937
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-5078
  • Fax:
Mailing address:
  • Phone: 760-745-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10617
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: