Provider Demographics
NPI:1003288556
Name:HANKS, CASEY RAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:RAY
Last Name:HANKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 LAKELAND ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1016
Mailing Address - Country:US
Mailing Address - Phone:863-661-5645
Mailing Address - Fax:
Practice Address - Street 1:12360 LAKELAND ACRES RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-1016
Practice Address - Country:US
Practice Address - Phone:863-661-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist