Provider Demographics
NPI:1891391603
Name:CARSON, CHERESSE BOLDS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHERESSE
Middle Name:BOLDS
Last Name:CARSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27199 N 86TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3675
Mailing Address - Country:US
Mailing Address - Phone:623-680-2969
Mailing Address - Fax:623-975-6221
Practice Address - Street 1:13940 W MEEKER BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4492
Practice Address - Country:US
Practice Address - Phone:623-975-6221
Practice Address - Fax:623-975-6223
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist