Provider Demographics
NPI:1962710236
Name:CASSIDY, DARLENE MAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:MAE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 HARTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8242
Mailing Address - Country:US
Mailing Address - Phone:256-830-6636
Mailing Address - Fax:
Practice Address - Street 1:138 HARTINGTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8242
Practice Address - Country:US
Practice Address - Phone:256-830-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033379183500000X
AL11647 EXP 12/31/2016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11647OtherSTATE LICENSE NUMBER
AL11647OtherSTATE BOARD OF PHARMACY