Provider Demographics
NPI:1396175824
Name:ENDICOTT, CASEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:ENDICOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 LYON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1066
Mailing Address - Country:US
Mailing Address - Phone:606-367-0336
Mailing Address - Fax:
Practice Address - Street 1:3332 LYON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1066
Practice Address - Country:US
Practice Address - Phone:606-367-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist