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General NPI Number Information
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NPI Number | 1780665562
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Entity Type | Individual
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Provider Name | PAUL FRANCIS LEIBOLD R.PH.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1150 W LOCUST ST SUITE 100
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City | WILMINGTON
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State | OH
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Zip | 45177-2572
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Country | US
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Telephone | 937-382-6717
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Fax | 937-383-2990
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Provider Business Mailing Address
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Address Line | 1955 E FORK RD
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City | NEW VIENNA
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State | OH
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Zip | 45159-9513
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Country | US
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Telephone | 937-382-6717
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Fax | 937-383-2990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19005
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License Number State | OH
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