Healthcare Provider Details

I. General information

NPI: 1932799491
Provider Name (Legal Business Name): CASEY HULL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY GREENE

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S BROADVIEW ST
GREENBRIER AR
72058-9231
US

IV. Provider business mailing address

75 S BROADVIEW ST
GREENBRIER AR
72058-9231
US

V. Phone/Fax

Practice location:
  • Phone: 501-287-6007
  • Fax:
Mailing address:
  • Phone: 501-287-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD12621
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: