Provider Demographics
NPI:1528380805
Name:KAATZ, CASEY (RPH)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KAATZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 BENOIT RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-3308
Mailing Address - Country:US
Mailing Address - Phone:810-794-3698
Mailing Address - Fax:
Practice Address - Street 1:67300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1920
Practice Address - Country:US
Practice Address - Phone:586-727-2754
Practice Address - Fax:586-727-9599
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist