Provider Demographics
NPI:1073124947
Name:CASELLA, CARISSA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ROSE
Last Name:CASELLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3601
Mailing Address - Country:US
Mailing Address - Phone:610-861-7494
Mailing Address - Fax:610-861-9028
Practice Address - Street 1:2240 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3601
Practice Address - Country:US
Practice Address - Phone:610-861-7494
Practice Address - Fax:610-861-9028
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist