Provider Demographics
NPI:1093315673
Name:EASLEY, CASEY E (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:E
Last Name:EASLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:E
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:800 JAMES BOWIE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2334
Mailing Address - Country:US
Mailing Address - Phone:903-628-6561
Mailing Address - Fax:903-628-5678
Practice Address - Street 1:800 JAMES BOWIE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2334
Practice Address - Country:US
Practice Address - Phone:903-628-6561
Practice Address - Fax:903-628-5678
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist