Healthcare Provider Details

I. General information

NPI: 1265507388
Provider Name (Legal Business Name): PATRICK MORALEDA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N UNIVERSITY ISU HEALTH SERVICE PHARMACY
NORMAL IL
61790-2540
US

IV. Provider business mailing address

2 JILL CT
BLOOMINGTON IL
61701-2011
US

V. Phone/Fax

Practice location:
  • Phone: 309-438-8713
  • Fax: 309-438-7569
Mailing address:
  • Phone: 309-828-5078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: