Provider Demographics
NPI:1699053439
Name:PATTERSON, CASEY SUPERCHI (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:SUPERCHI
Last Name:PATTERSON
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 1:9229 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5502
Mailing Address - Country:US
Mailing Address - Phone:036-499-7493
Mailing Address - Fax:970-870-1684
Practice Address - Street 1:9229 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5502
Practice Address - Country:US
Practice Address - Phone:036-499-7493
Practice Address - Fax:970-870-1684
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist