Provider Demographics
NPI:1023362225
Name:TRESSA DE CARO, ANALIA (RPH)
Entity Type:Individual
Prefix:
First Name:ANALIA
Middle Name:
Last Name:TRESSA DE CARO
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 1:3430 IRBY DR
Mailing Address - Street 2:APT. 304
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7422
Mailing Address - Country:US
Mailing Address - Phone:501-327-0510
Mailing Address - Fax:
Practice Address - Street 1:3430 IRBY DR
Practice Address - Street 2:APT. 304
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7422
Practice Address - Country:US
Practice Address - Phone:501-327-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12009183500000X
PARP446511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist