Provider Demographics
NPI:1407452444
Name:GOLAB, ADAM GREGORY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:GREGORY
Last Name:GOLAB
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 1:4037 S CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9107
Mailing Address - Country:US
Mailing Address - Phone:317-640-8336
Mailing Address - Fax:
Practice Address - Street 1:3808 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-4412
Practice Address - Country:US
Practice Address - Phone:317-357-5437
Practice Address - Fax:317-357-0487
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015338A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist