Provider Demographics
NPI:1316613623
Name:ELMORE, CASSIDY DARE (PHARMD)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:DARE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:DARE
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3936 SARGETT BROWN RD
Mailing Address - Street 2:
Mailing Address - City:DEEP RUN
Mailing Address - State:NC
Mailing Address - Zip Code:28525-9661
Mailing Address - Country:US
Mailing Address - Phone:252-526-7110
Mailing Address - Fax:
Practice Address - Street 1:4003 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9674
Practice Address - Country:US
Practice Address - Phone:252-559-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist