Healthcare Provider Details

I. General information

NPI: 1023951530
Provider Name (Legal Business Name): CECILY VIVAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 BOURBON ST APT F
LAUREL MD
20723-1643
US

IV. Provider business mailing address

9165 BOURBON ST APT F
LAUREL MD
20723-1643
US

V. Phone/Fax

Practice location:
  • Phone: 804-926-0231
  • Fax:
Mailing address:
  • Phone: 804-926-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: