Provider Demographics
NPI:1073043063
Name:SOUDERS, CASEY LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:SOUDERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2410
Mailing Address - Country:US
Mailing Address - Phone:205-951-0355
Mailing Address - Fax:205-956-3912
Practice Address - Street 1:1600 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2410
Practice Address - Country:US
Practice Address - Phone:205-951-0355
Practice Address - Fax:205-956-3912
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist