Provider Demographics
NPI:1720129299
Name:CASEY, JUDITH ZOCK (R PH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ZOCK
Last Name:CASEY
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1654
Mailing Address - Country:US
Mailing Address - Phone:814-886-8825
Mailing Address - Fax:
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1539
Practice Address - Country:US
Practice Address - Phone:814-736-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029958L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist