MEDICARE: CASEY DRUG-A INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043863723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY DRUG-A INC

Provider Business Mailing Address
First Line	:	121 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1818
Country	:	US
Telephone Number	:	218-254-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1818
Country	:	US
Telephone Number	:	218-254-3318
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	ALIDA ERIN CASEY
Credential	:	PHARMD
Telephone Number	:	218-254-3318

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	03/17/2022

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Directions to “CASEY DRUG-A INC ” Practice Location

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