Healthcare Provider Details

I. General information

NPI: 1265928345
Provider Name (Legal Business Name): MICHAEL ROSS CASEY PHARMD, CDOE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 HARTFORD AVE
JOHNSTON RI
02919-7109
US

IV. Provider business mailing address

49 DEERFIELD DR
WEST WARWICK RI
02893-3235
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-1940
  • Fax: 401-351-6613
Mailing address:
  • Phone: 401-524-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04919
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: