Provider Demographics
NPI:1104089127
Name:CASSERLY, JILL ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:CASSERLY
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 1:1003 12TH ST
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1626
Mailing Address - Country:US
Mailing Address - Phone:919-575-7394
Mailing Address - Fax:
Practice Address - Street 1:1003 12TH ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1626
Practice Address - Country:US
Practice Address - Phone:919-575-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189231835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric