Healthcare Provider Details

I. General information

NPI: 1740715499
Provider Name (Legal Business Name): PAUL MICHAEL CASEBOLT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 W MAIN ST STE 401
NEWARK OH
43055-2056
US

IV. Provider business mailing address

127 STONE CREEK DR
GRANVILLE OH
43023-8030
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-2570
  • Fax: 866-291-1460
Mailing address:
  • Phone: 740-334-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-27123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: