Provider Demographics
NPI:1083801575
Name:CASEBOLT, MARY N (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 PARKWAY HLS
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9582
Mailing Address - Country:US
Mailing Address - Phone:606-878-1486
Mailing Address - Fax:
Practice Address - Street 1:237 PARKWAY HLS
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-9582
Practice Address - Country:US
Practice Address - Phone:606-878-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist