Provider Demographics
NPI:1891279436
Name:CERESA, CARRIE MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:CERESA
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 1:10903 NEW HAMPSHIRE AVE BLDG 22
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1058
Mailing Address - Country:US
Mailing Address - Phone:301-796-4108
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE BLDG 22
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1058
Practice Address - Country:US
Practice Address - Phone:301-796-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist