Provider Demographics
NPI:1578181913
Name:FORNESS, ADAM MARSHALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MARSHALL
Last Name:FORNESS
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 1:1109 170TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOLVERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56594-9523
Mailing Address - Country:US
Mailing Address - Phone:701-388-4676
Mailing Address - Fax:
Practice Address - Street 1:1109 170TH AVE
Practice Address - Street 2:
Practice Address - City:WOLVERTON
Practice Address - State:MN
Practice Address - Zip Code:56594-9523
Practice Address - Country:US
Practice Address - Phone:701-388-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist