Provider Demographics
NPI:1497851075
Name:LINEBAUGH, DALE JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:JAY
Last Name:LINEBAUGH
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 1:1121 CIRCLE ON THE GRN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1214
Mailing Address - Country:US
Mailing Address - Phone:614-848-3163
Mailing Address - Fax:
Practice Address - Street 1:1121 CIRCLE ON THE GRN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1214
Practice Address - Country:US
Practice Address - Phone:614-848-3163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-14852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist