Provider Demographics
NPI:1649843038
Name:CASEY, MARY HELEN
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:HELEN
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HELEN
Other - Last Name:BROKAW,HAMMOND,RUFFNER,HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:BANGS
Mailing Address - State:TX
Mailing Address - Zip Code:76823-0040
Mailing Address - Country:US
Mailing Address - Phone:903-413-1122
Mailing Address - Fax:
Practice Address - Street 1:501 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-4623
Practice Address - Country:US
Practice Address - Phone:325-236-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist