Provider Demographics
NPI:1174231617
Name:CASANOVA, ALEXA BAILEY
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:BAILEY
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4500
Mailing Address - Country:US
Mailing Address - Phone:484-213-3262
Mailing Address - Fax:
Practice Address - Street 1:2000 CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3010
Practice Address - Country:US
Practice Address - Phone:412-655-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist