Provider Demographics
NPI:1801395314
Name:WEST, KASEY (CPHT)
Entity Type:Individual
Prefix:MR
First Name:KASEY
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 STONECASTLE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7879
Mailing Address - Country:US
Mailing Address - Phone:407-485-3454
Mailing Address - Fax:
Practice Address - Street 1:10425 NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6902
Practice Address - Country:US
Practice Address - Phone:407-384-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30031636183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
30031636OtherPHARMACY TECHNICIAN CERTIFICATION BOARD
FL66496OtherDEPARTMENT OF HEALTH