Provider Demographics
NPI:1467465021
Name:CASPER, SUSAN DIANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANNE
Last Name:CASPER
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:PO BOX 311
Mailing Address - Street 2:504 KIMBLE AVE
Mailing Address - City:SWINK
Mailing Address - State:CO
Mailing Address - Zip Code:81077-0311
Mailing Address - Country:US
Mailing Address - Phone:719-383-3993
Mailing Address - Fax:719-383-3993
Practice Address - Street 1:228 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1403
Practice Address - Country:US
Practice Address - Phone:719-267-3544
Practice Address - Fax:719-267-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17258183500000X
KS13645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist