Provider Demographics
NPI:1801978739
Name:WOOD HARRELL, CASEY A (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:A
Last Name:WOOD HARRELL
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:PO BOX 1635
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-1635
Mailing Address - Country:US
Mailing Address - Phone:360-642-0740
Mailing Address - Fax:360-642-8786
Practice Address - Street 1:101 BOLSTAD AVENUE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631
Practice Address - Country:US
Practice Address - Phone:360-642-2349
Practice Address - Fax:360-642-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist