Provider Demographics
NPI:1477008621
Name:POWERS, CASEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3216
Mailing Address - Country:US
Mailing Address - Phone:802-254-2303
Mailing Address - Fax:802-257-0023
Practice Address - Street 1:20 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3216
Practice Address - Country:US
Practice Address - Phone:802-254-2303
Practice Address - Fax:802-257-0023
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0120977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist