Casey Jo Blom, PHARMD
Individual provider Active NPI Pharmacist · Coleman, WI
NPI 1780969808 · NPPES record last updated Nov 17, 2020
Key facts
- NPI
- 1780969808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 14567-040 (WI)
- Practice address
- 633 Business 141 N
Coleman, WI 54112-9416 - Phone
- (920) 897-5333
- Fax
- (920) 897-5451
- NPI assigned
- Oct 20, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14567-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mag RX LLC | Current | Accepting new patients | |
| Village Pharmacy Inc | Past | Accepting new patients |
Locations
633 Highway 141
Coleman, WI 54112
Phone (920) 897-5333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14567-040 | WI | Yes |
Addresses
Primary practice location
633 Business 141 N
Coleman, WI 54112-9416
Mailing address
633 Business 141 N
Coleman, WI 54112-9416
Phone (920) 897-5333
Other providers in Coleman, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.