MEDICARE: MR. DONALD BRANDT CASEY PHARMD

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	183500000X	Pharmacist	15005	OK

General Provider Information

NPI Number	:	1063092773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD BRANDT CASEY PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0247
Country	:	US
Telephone Number	:	405-454-2476
Fax Number	:	405-454-3507

Provider Business Practice Location Address
First Line	:	2060 NORTH CHURCH AVE
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-7304
Country	:	US
Telephone Number	:	405-454-2476
Fax Number	:	405-454-3507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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