Provider Demographics
NPI:1053890228
Name:ZIAC, CASEY (RPH, PHARM D)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ZIAC
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BLUFFTON PKWY APT 522
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4654
Mailing Address - Country:US
Mailing Address - Phone:607-221-1426
Mailing Address - Fax:
Practice Address - Street 1:85 MATHEWS DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3609
Practice Address - Country:US
Practice Address - Phone:843-681-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist