=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225657224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ELIZABETH CASEY CPHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2020
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4062 HIXSON PIKE
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37415-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-877-3568
-----------------------------------------------------
Fax | 423-362-4875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4062 HIXSON PIKE
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37415-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-877-3568
-----------------------------------------------------
Fax | 423-362-4875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 0000056060
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------