Healthcare Provider Details

I. General information

NPI: 1073866810
Provider Name (Legal Business Name): TREVOR C CASEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

IV. Provider business mailing address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5082
  • Fax:
Mailing address:
  • Phone: 207-288-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3269
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR12740
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: