Provider Demographics
NPI:1932476785
Name:SUMMERS, CASEY MICHELLE
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MICHELLE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3706
Mailing Address - Country:US
Mailing Address - Phone:812-277-9375
Mailing Address - Fax:812-277-9458
Practice Address - Street 1:1215 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3706
Practice Address - Country:US
Practice Address - Phone:812-277-9375
Practice Address - Fax:812-277-9458
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021633A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist