Healthcare Provider Details

I. General information

NPI: 1215587464
Provider Name (Legal Business Name): CASEY ALLEN PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N STATE ST
OREM UT
84057-3802
US

IV. Provider business mailing address

51 W CENTER ST # 312
OREM UT
84057-4605
US

V. Phone/Fax

Practice location:
  • Phone: 801-434-7670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4189
License Number StateWY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: