Provider Demographics
NPI:1306373766
Name:KOETTER, ADAM CHARLES
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:CHARLES
Last Name:KOETTER
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 1:1253 W FALDO DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8521
Mailing Address - Country:US
Mailing Address - Phone:520-258-8239
Mailing Address - Fax:
Practice Address - Street 1:3800 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2240
Practice Address - Country:US
Practice Address - Phone:520-258-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0229411835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care