Provider Demographics
NPI:1790902666
Name:CASSITY, JIMMY LEE (RPH)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:LEE
Last Name:CASSITY
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:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-0916
Mailing Address - Country:US
Mailing Address - Phone:719-588-4377
Mailing Address - Fax:
Practice Address - Street 1:222 SOLAR AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1066
Practice Address - Country:US
Practice Address - Phone:719-852-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist