Provider Demographics
NPI:1093453557
Name:COTTON, CASSIDY PAIGE
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:PAIGE
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-4360
Mailing Address - Country:US
Mailing Address - Phone:660-654-2225
Mailing Address - Fax:
Practice Address - Street 1:6365 LEWIS DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3699
Practice Address - Country:US
Practice Address - Phone:816-505-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022015868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist