Provider Demographics
NPI:1639849581
Name:CASSATT, KEVIN (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:CASSATT
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:CASSATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSPHARM
Mailing Address - Street 1:1227 EAST RUSHOLME STREET
Mailing Address - Street 2:ATTN: DEPARTMENT OF PHARMACY
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-421-6212
Mailing Address - Fax:563-421-6198
Practice Address - Street 1:1227 EAST RUSHOLME STREET
Practice Address - Street 2:ATTN: DEPARTMENT OF PHARMACY
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-421-6212
Practice Address - Fax:563-421-6198
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC17052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist