Provider Demographics
NPI:1417355512
Name:ADLY, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ADLY
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 1:7496 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8550
Mailing Address - Country:US
Mailing Address - Phone:513-328-2456
Mailing Address - Fax:
Practice Address - Street 1:7496 ALEXANDRA DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8550
Practice Address - Country:US
Practice Address - Phone:513-328-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist