Provider Demographics
NPI:1619521770
Name:CERECERES, DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CERECERES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-7291
Mailing Address - Country:US
Mailing Address - Phone:915-494-5830
Mailing Address - Fax:
Practice Address - Street 1:700 S OCHOA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-2936
Practice Address - Country:US
Practice Address - Phone:915-494-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650491835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care