Healthcare Provider Details

I. General information

NPI: 1689288391
Provider Name (Legal Business Name): BRIAN DOUGLAS CASWELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MILITARY AVE
BAXTER SPRINGS KS
66713-2039
US

IV. Provider business mailing address

1920 MILITARY AVE
BAXTER SPRINGS KS
66713-2039
US

V. Phone/Fax

Practice location:
  • Phone: 620-856-5555
  • Fax: 620-856-3455
Mailing address:
  • Phone: 620-856-5555
  • Fax: 620-856-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-13206
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: