Provider Demographics
NPI:1669828117
Name:MCCANN, KASEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:BRANTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6906 81ST AVE S
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-9799
Mailing Address - Country:US
Mailing Address - Phone:952-300-7847
Mailing Address - Fax:
Practice Address - Street 1:2425 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3749
Practice Address - Country:US
Practice Address - Phone:701-232-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122120183500000X
NE14619183500000X
NDRPH5846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist