Basic Information
| Provider Information | |||||||||
| NPI: | 1265928345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD, CDOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 DEERFIELD DR | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028933235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015240281 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1126 HARTFORD AVE | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029197109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015191940 | ||||||||
| FaxNumber: | 4013516613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2018 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH04919 | RI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.