Provider Demographics
NPI:1336424076
Name:TUBB, KASEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:TUBB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 COUNTY ROAD 505
Mailing Address - Street 2:
Mailing Address - City:WAPPAPELLO
Mailing Address - State:MO
Mailing Address - Zip Code:63966-8310
Mailing Address - Country:US
Mailing Address - Phone:573-297-3760
Mailing Address - Fax:
Practice Address - Street 1:1500 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3318
Practice Address - Country:US
Practice Address - Phone:573-778-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist