Provider Demographics
NPI:1275897696
Name:PENA, KASEY LEGGETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LEGGETTE
Last Name:PENA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:RENEE
Other - Last Name:LEGGETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4110 GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4223
Mailing Address - Country:US
Mailing Address - Phone:512-419-2759
Mailing Address - Fax:512-419-2788
Practice Address - Street 1:4110 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4223
Practice Address - Country:US
Practice Address - Phone:512-419-2759
Practice Address - Fax:512-419-2788
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51423183500000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist