Provider Demographics
NPI:1215535000
Name:ADAMOVICH, JAMI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:ADAMOVICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E8991 KANAMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-8716
Mailing Address - Country:US
Mailing Address - Phone:920-740-0738
Mailing Address - Fax:
Practice Address - Street 1:1717 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9365
Practice Address - Country:US
Practice Address - Phone:920-982-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14177-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist