Provider Demographics
NPI:1881906428
Name:CASEY, ALIDA ERIN (PHARM D)
Entity type:Individual
Prefix:MS
First Name:ALIDA
Middle Name:ERIN
Last Name:CASEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1818
Mailing Address - Country:US
Mailing Address - Phone:218-254-3318
Mailing Address - Fax:218-254-7643
Practice Address - Street 1:111 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1818
Practice Address - Country:US
Practice Address - Phone:218-254-3318
Practice Address - Fax:218-254-7643
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist