Provider Demographics
NPI:1598307050
Name:SLUDER, CASEY M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:SLUDER
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 1:305 TANNERS MILL CT
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9275
Mailing Address - Country:US
Mailing Address - Phone:803-528-1402
Mailing Address - Fax:
Practice Address - Street 1:1216 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2453
Practice Address - Country:US
Practice Address - Phone:803-358-3030
Practice Address - Fax:803-358-3034
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherN/A