Provider Demographics
NPI:1518534973
Name:CASEY, ALYSSA ELAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ELAINE
Last Name:CASEY
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0247
Mailing Address - Country:US
Mailing Address - Phone:405-454-2476
Mailing Address - Fax:405-454-3507
Practice Address - Street 1:2060 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-0247
Practice Address - Country:US
Practice Address - Phone:405-454-2476
Practice Address - Fax:405-454-3507
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist