Provider Demographics
NPI:1982908984
Name:CASSIS, DEDE
Entity Type:Individual
Prefix:
First Name:DEDE
Middle Name:
Last Name:CASSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEDE
Other - Middle Name:
Other - Last Name:CASSIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25186-0577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186-0577
Practice Address - Country:US
Practice Address - Phone:304-442-2156
Practice Address - Fax:304-442-2159
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3890183500000X
VA0202007665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist