Provider Demographics
NPI:1588267264
Name:DEVINE, CASSANDRA K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:K
Last Name:DEVINE
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 1:1831 LONGVIEW ST APT 316
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2584
Mailing Address - Country:US
Mailing Address - Phone:816-604-9278
Mailing Address - Fax:
Practice Address - Street 1:4001 N 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1839
Practice Address - Country:US
Practice Address - Phone:402-431-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029138183500000X
SD6828183500000X
IA24046183500000X
NE16930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist