Healthcare Provider Details

I. General information

NPI: 1295087872
Provider Name (Legal Business Name): ALICE C. CEACAREANU PHARMD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON OUTPATIENT LEUKEMIA CLINIC
BUFFALO NY
14260-0001
US

IV. Provider business mailing address

701 ELLICOTT ST RM B4-308
BUFFALO NY
14203-1101
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-8441
  • Fax:
Mailing address:
  • Phone: 716-881-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number56665
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19399
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP442395
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number29481
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46686
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP010275
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: