Provider Demographics
NPI:1326472499
Name:GOBBLE, CASEY JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JONATHAN
Last Name:GOBBLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5907
Mailing Address - Country:US
Mailing Address - Phone:208-319-0543
Mailing Address - Fax:208-319-0543
Practice Address - Street 1:1315 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2416
Practice Address - Country:US
Practice Address - Phone:801-616-5223
Practice Address - Fax:801-616-5252
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT771658-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist