Provider Demographics
NPI:1316188634
Name:SOUSA, CARLA M (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:M
Last Name:SOUSA
Suffix:
Gender:F
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 1:12 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1622
Mailing Address - Country:US
Mailing Address - Phone:914-674-1201
Mailing Address - Fax:
Practice Address - Street 1:196 E HARTSDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3505
Practice Address - Country:US
Practice Address - Phone:915-725-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist