Provider Demographics
NPI:1447852439
Name:CASWELL, DONALD WAYNE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:CASWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:EUSTACE
Mailing Address - State:TX
Mailing Address - Zip Code:75124-0134
Mailing Address - Country:US
Mailing Address - Phone:903-880-6106
Mailing Address - Fax:
Practice Address - Street 1:1200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-5320
Practice Address - Country:US
Practice Address - Phone:903-887-2133
Practice Address - Fax:903-887-3506
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist