Provider Demographics
NPI:1073114070
Name:KULAGO, CASEY JOE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JOE
Last Name:KULAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S ATHERTON ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7610
Mailing Address - Country:US
Mailing Address - Phone:814-861-2790
Mailing Address - Fax:814-238-1328
Practice Address - Street 1:2121 S ATHERTON ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7610
Practice Address - Country:US
Practice Address - Phone:814-861-2790
Practice Address - Fax:814-238-1328
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist