Provider Demographics
NPI:1235492539
Name:CERRA, DANIEL JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:CERRA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HOOFBEAT LN
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:MO
Mailing Address - Zip Code:65591-8202
Mailing Address - Country:US
Mailing Address - Phone:573-216-2599
Mailing Address - Fax:
Practice Address - Street 1:154 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAVOIS MILLS
Practice Address - State:MO
Practice Address - Zip Code:65037-6196
Practice Address - Country:US
Practice Address - Phone:573-207-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist