Provider Demographics
NPI:1700211547
Name:BOOTH, ADAM C (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:BOOTH
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 1:780 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1610
Mailing Address - Country:US
Mailing Address - Phone:330-336-2550
Mailing Address - Fax:330-336-2506
Practice Address - Street 1:780 HIGH ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1610
Practice Address - Country:US
Practice Address - Phone:330-336-2550
Practice Address - Fax:330-336-2506
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist