Provider Demographics
NPI:1215693981
Name:CASULA, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:CASULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5103
Mailing Address - Country:US
Mailing Address - Phone:800-767-7772
Mailing Address - Fax:
Practice Address - Street 1:700 PATCHOGUE YAPHANK RD STE 60
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2239
Practice Address - Country:US
Practice Address - Phone:631-345-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist