Provider Demographics
NPI:1093006058
Name:CASILLAS, ADOLF O (RPH)
Entity Type:Individual
Prefix:
First Name:ADOLF
Middle Name:O
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S WILHELM ST
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:OH
Mailing Address - Zip Code:43527-9565
Mailing Address - Country:US
Mailing Address - Phone:419-966-6282
Mailing Address - Fax:
Practice Address - Street 1:1816 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2502
Practice Address - Country:US
Practice Address - Phone:419-782-7832
Practice Address - Fax:419-782-3173
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist