Provider Demographics
NPI:1518365634
Name:FANELLE, ADAM M (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:FANELLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2643
Mailing Address - Country:US
Mailing Address - Phone:856-357-9302
Mailing Address - Fax:
Practice Address - Street 1:143 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2643
Practice Address - Country:US
Practice Address - Phone:856-357-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI012919183500000X
MD22988183500000X
DCPH100001857183500000X
NJ28RI03700100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist