Provider Demographics
NPI:1588674154
Name:MCFADDEN, CASEY RYAN
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:RYAN
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612
Mailing Address - Country:US
Mailing Address - Phone:740-634-3231
Mailing Address - Fax:740-634-3236
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:45612
Practice Address - Country:US
Practice Address - Phone:740-634-3231
Practice Address - Fax:740-634-3236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0332164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist