Provider Demographics
NPI:1538403126
Name:HOIDA, CASEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:HOIDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 DISCOVERY ROAD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:920-288-5142
Mailing Address - Fax:920-288-5152
Practice Address - Street 1:931 DISCOVERY RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8002
Practice Address - Country:US
Practice Address - Phone:920-288-5142
Practice Address - Fax:920-288-5152
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15439-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist