Healthcare Provider Details

I. General information

NPI: 1619521770
Provider Name (Legal Business Name): DAVID CERECERES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

IV. Provider business mailing address

5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-494-5830
  • Fax:
Mailing address:
  • Phone: 505-564-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65049
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number65049
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number65049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: