MEDICARE: DENIS JOHN CASEY RPH

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	36475	NY
2	1835X0200X	Oncology Pharmacist	36475	NY

General Provider Information

NPI Number	:	1912299512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENIS JOHN CASEY RPH

Provider Business Mailing Address
First Line	:	19 VILLAGE VIEW BLF
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1205
Country	:	US
Telephone Number	:	518-281-7624
Fax Number	:	518-281-7624

Provider Business Practice Location Address
First Line	:	19 VILLAGE VIEW BLF
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1205
Country	:	US
Telephone Number	:	518-281-7624
Fax Number	:	518-281-7624

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

Provider Enumeration Date	:	05/15/2011
Last Update Date	:	05/15/2011

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