Provider Demographics
NPI:1295087872
Name:CEACAREANU, ALICE C (PHARMD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:CEACAREANU
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ELLICOTT ST
Mailing Address - Street 2:RM B4-308
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1101
Mailing Address - Country:US
Mailing Address - Phone:716-881-7502
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON
Practice Address - Street 2:OUTPATIENT LEUKEMIA CLINIC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-0001
Practice Address - Country:US
Practice Address - Phone:716-845-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566651835P0018X
NC193991835P0018X
PARP4423951835P0018X
TN294811835P0018X
TX466861835P0018X
MSP0102751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN29481OtherTENNESSEE BOARD OF PHARMACY
PARP442395OtherPENNSYLVANIA BOARD OF PHARMACY
NY56665OtherNYS BOARD OF PHARMACY
TX46686OtherTEXAS BOARD OF PHARMACY
NC19399OtherNORTH CAROLINA BOARD OF PHARMACY
MSP010275OtherMISSISSIPPI BOARD OF PHARMACY