Provider Demographics
NPI:1871276527
Name:CASEY, JADE (RPH)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:SHREVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 CHERRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:551 VETERANS UNITED DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8397
Practice Address - Country:US
Practice Address - Phone:573-882-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023031333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist