Provider Demographics
NPI:1134709256
Name:CEJA, ALYSSA MARIE (PHARMACY TECH)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:MARIE
Last Name:CEJA
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 RODD FIELD RD APT 15205
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2150
Mailing Address - Country:US
Mailing Address - Phone:361-222-9989
Mailing Address - Fax:
Practice Address - Street 1:1600 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2816
Practice Address - Country:US
Practice Address - Phone:361-642-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288888183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician