Provider Demographics
NPI:1821375320
Name:CASSINO, CELESTE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:M
Last Name:CASSINO
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 1:5650 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6641
Mailing Address - Country:US
Mailing Address - Phone:540-786-5883
Mailing Address - Fax:540-785-9088
Practice Address - Street 1:5650 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6641
Practice Address - Country:US
Practice Address - Phone:540-786-5883
Practice Address - Fax:540-785-9088
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24090183500000X
VA0202205541183500000X
TN12738183500000X
AL15482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist