Provider Demographics
NPI:1518307636
Name:PUTNAM, CASSIDY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LYNN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3025
Mailing Address - Country:US
Mailing Address - Phone:970-337-0300
Mailing Address - Fax:
Practice Address - Street 1:4502 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3025
Practice Address - Country:US
Practice Address - Phone:970-337-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19497OtherPHARMACIST LISCENSE