Provider Demographics
NPI:1215150966
Name:GARDNER, CASEY KIMZEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:KIMZEY
Last Name:GARDNER
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 1:1110 NAVAHO DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7352
Mailing Address - Country:US
Mailing Address - Phone:919-713-1562
Mailing Address - Fax:
Practice Address - Street 1:1110 NAVAHO DR
Practice Address - Street 2:SUITE 400
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7352
Practice Address - Country:US
Practice Address - Phone:919-713-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172091835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric