Provider Demographics
NPI:1154644920
Name:ADAM LLC
Entity Type:Organization
Organization Name:ADAM LLC
Other - Org Name:PHARMACY ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUHANIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-496-7000
Mailing Address - Street 1:201 N YELLOW SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2650
Mailing Address - Country:US
Mailing Address - Phone:937-496-7000
Mailing Address - Fax:937-496-7004
Practice Address - Street 1:201 N YELLOW SPRINGS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2650
Practice Address - Country:US
Practice Address - Phone:937-496-7000
Practice Address - Fax:937-496-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OHRTP.022018450-33336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124043OtherPK