Provider Demographics
NPI:1841624939
Name:GROSS, CASEY ROBINSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ROBINSON
Last Name:GROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8100 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8425
Mailing Address - Country:US
Mailing Address - Phone:208-375-2825
Mailing Address - Fax:208-375-2846
Practice Address - Street 1:8100 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8425
Practice Address - Country:US
Practice Address - Phone:208-375-2825
Practice Address - Fax:208-375-2846
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7132396183500000X
IDP6876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist