Provider Demographics
NPI:1437496296
Name:KESHISHIAN, CESIL
Entity Type:Individual
Prefix:
First Name:CESIL
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CORAL HILLS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4146
Mailing Address - Country:US
Mailing Address - Phone:954-379-4153
Mailing Address - Fax:
Practice Address - Street 1:2901 CORAL HILLS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4146
Practice Address - Country:US
Practice Address - Phone:954-379-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS024024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42228OtherBOARD OF PHARMACY
FLPS024024OtherSTATE LICENSE