Provider Demographics
NPI:1588077119
Name:RICASA, MARIA VIRAY
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRAY
Last Name:RICASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13126 HOLDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3935
Mailing Address - Country:US
Mailing Address - Phone:301-646-2529
Mailing Address - Fax:
Practice Address - Street 1:403 GEORGE CLAUSS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1317
Practice Address - Country:US
Practice Address - Phone:410-424-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist