Provider Demographics
NPI:1710694617
Name:CASADY, DAVID BRIAN (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:CASADY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-5321
Mailing Address - Country:US
Mailing Address - Phone:903-887-6498
Mailing Address - Fax:903-887-3136
Practice Address - Street 1:1279 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5321
Practice Address - Country:US
Practice Address - Phone:903-887-6498
Practice Address - Fax:903-887-3136
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist