Provider Demographics
NPI:1780665562
Name:LEIBOLD, PAUL FRANCIS (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FRANCIS
Last Name:LEIBOLD
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 1:1955 E FORK RD
Mailing Address - Street 2:
Mailing Address - City:NEW VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:45159-9513
Mailing Address - Country:US
Mailing Address - Phone:937-382-6717
Mailing Address - Fax:937-383-2990
Practice Address - Street 1:1150 W LOCUST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2572
Practice Address - Country:US
Practice Address - Phone:937-382-6717
Practice Address - Fax:937-383-2990
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist