Healthcare Provider Details

I. General information

NPI: 1588674154
Provider Name (Legal Business Name): MR. CASEY RYAN MCFADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
BAINBRIDGE OH
45612
US

IV. Provider business mailing address

115 E MAIN ST
BAINBRIDGE OH
45612
US

V. Phone/Fax

Practice location:
  • Phone: 740-634-3231
  • Fax: 740-634-3236
Mailing address:
  • Phone: 740-634-3231
  • Fax: 740-634-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0332164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: