Provider Demographics
NPI:1790177137
Name:GUILFOYLE, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GUILFOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1726
Mailing Address - Country:US
Mailing Address - Phone:513-831-4269
Mailing Address - Fax:513-965-3648
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1726
Practice Address - Country:US
Practice Address - Phone:513-831-4269
Practice Address - Fax:513-965-3648
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist