Healthcare Provider Details

I. General information

NPI: 1235492539
Provider Name (Legal Business Name): DANIEL JAMES CERRA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S MAIN ST
GRAVOIS MILLS MO
65037-6196
US

IV. Provider business mailing address

185 HOOFBEAT LN
MONTREAL MO
65591-8202
US

V. Phone/Fax

Practice location:
  • Phone: 573-207-0805
  • Fax:
Mailing address:
  • Phone: 573-216-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004034213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: