Healthcare Provider Details

I. General information

NPI: 1982908984
Provider Name (Legal Business Name): DEDE CASSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEDE CASSIS

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 VIRGINIA AVE
SMITHERS WV
25186-0577
US

IV. Provider business mailing address

PO BOX 577
SMITHERS WV
25186-0577
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-2156
  • Fax: 304-442-2159
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3890
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: