MEDICARE: ADEN CASEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	727455	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	727455	OTHER	MN	BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number	:	1629694765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEN CASEY PHARMD

Provider Business Mailing Address
First Line	:	121 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1818
Country	:	US
Telephone Number	:	218-254-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1818
Country	:	US
Telephone Number	:	218-254-3318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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Directions to “ ADEN CASEY PHARMD” Practice Location

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