Provider Demographics
NPI:1285983999
Name:KASSERMAN, RAEGAN ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:RAEGAN
Middle Name:ANN
Last Name:KASSERMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:RAEGAN
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:7 RENAISSANCE WAY
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4867
Mailing Address - Country:US
Mailing Address - Phone:304-232-7698
Mailing Address - Fax:
Practice Address - Street 1:104 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8736
Practice Address - Country:US
Practice Address - Phone:740-695-0274
Practice Address - Fax:740-695-2412
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127438183500000X
WVRP 0006596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist