Provider Demographics
NPI:1043863723
Name:CASEY DRUG-A INC
Entity Type:Organization
Organization Name:CASEY DRUG-A INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIDA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:218-254-3318
Mailing Address - Street 1:121 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1818
Mailing Address - Country:US
Mailing Address - Phone:218-254-3318
Mailing Address - Fax:
Practice Address - Street 1:121 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1818
Practice Address - Country:US
Practice Address - Phone:218-254-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340560500Medicaid