Provider Demographics
NPI:1609144716
Name:HALCROW, CASEY CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:CHARLES
Last Name:HALCROW
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 1:2643 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2910
Mailing Address - Country:US
Mailing Address - Phone:612-789-6251
Mailing Address - Fax:
Practice Address - Street 1:2643 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2910
Practice Address - Country:US
Practice Address - Phone:612-789-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120019OtherMINNESOTA PHARMACIST LICENSE