Provider Demographics
NPI:1649749391
Name:TODD, CASEY MARTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MARTIN
Last Name:TODD
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:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-0615
Mailing Address - Country:US
Mailing Address - Phone:405-872-5335
Mailing Address - Fax:405-872-8267
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-9622
Practice Address - Country:US
Practice Address - Phone:405-872-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK176021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist