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General NPI Number Information
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NPI Number | 1598377491
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Entity Type | Individual
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Provider Name | CHARLES CASSIDY PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 1804 ELTON RD
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City | JENNINGS
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State | LA
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Zip | 70546-3002
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Country | US
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Telephone | 337-824-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 802 MAGNOLIA DR
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City | JENNINGS
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State | LA
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Zip | 70546-3820
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Country | US
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Telephone | 337-368-5701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PST.023514
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License Number State | LA
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