Healthcare Provider Details

I. General information

NPI: 1063092773
Provider Name (Legal Business Name): DONALD BRANDT CASEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 NORTH CHURCH AVE
HARRAH OK
73045-7304
US

IV. Provider business mailing address

PO BOX 247
HARRAH OK
73045-0247
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-2476
  • Fax: 405-454-3507
Mailing address:
  • Phone: 405-454-2476
  • Fax: 405-454-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15005
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: