Most Relevant Information
Provider Data
| NPI Number: | 1003475443 |
| Provider Name: | CASEY HAYCOCK CPHT |
| Entity Type: | Individual |
| Taxonomy Code: | 183700000X |
| Specialty: | Pharmacy Technician |
| License Number: | CT20939 |
Most Important Dates
| Enumeration Date: | 06/10/2019 |
| Last Updated: | 06/10/2019 |
Provider Practice Location
10500 W OVERLAND RD
BOISE
ID
837091435
Practice Location Phone/Fax
| Phone: | 2083764101 |
| Fax: |
Provider Mailing Location
10500 W OVERLAND RD
BOISE
ID
837091435
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |