Provider Demographics
NPI:1578169678
Name:WERNER, ADAM J
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:WERNER
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 1:1910 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-9091
Mailing Address - Country:US
Mailing Address - Phone:630-236-2240
Mailing Address - Fax:630-236-2246
Practice Address - Street 1:1910 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-9091
Practice Address - Country:US
Practice Address - Phone:630-236-2240
Practice Address - Fax:630-236-2240
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist