Provider Demographics
NPI:1437937224
Name:LANDRETH, CASEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:LANDRETH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 BUTTERFLY WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5540
Mailing Address - Country:US
Mailing Address - Phone:864-477-9458
Mailing Address - Fax:
Practice Address - Street 1:2700 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1152
Practice Address - Country:US
Practice Address - Phone:864-268-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist