Provider Demographics
NPI:1831807551
Name:STEWART, KASEY DEZERN (PHARMD)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:DEZERN
Last Name:STEWART
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 1:12000 ANCIENT CREST CIR APT 12304
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1446
Mailing Address - Country:US
Mailing Address - Phone:731-780-2549
Mailing Address - Fax:
Practice Address - Street 1:12000 ANCIENT CREST CIR APT 12304
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1446
Practice Address - Country:US
Practice Address - Phone:731-780-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty