Provider Demographics
NPI:1578817375
Name:PISTINER, ADAM JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JACOB
Last Name:PISTINER
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 1:424 E SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5224
Mailing Address - Country:US
Mailing Address - Phone:414-332-8380
Mailing Address - Fax:
Practice Address - Street 1:424 E SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5224
Practice Address - Country:US
Practice Address - Phone:414-332-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3849183500000X
WI16969-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist