Provider Demographics
NPI:1871191338
Name:MAHONEY, JAMES ADAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ADAM
Last Name:MAHONEY
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:W3205 KORTNEY LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-8547
Mailing Address - Country:US
Mailing Address - Phone:920-843-2418
Mailing Address - Fax:
Practice Address - Street 1:2292 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5307
Practice Address - Country:US
Practice Address - Phone:920-465-7737
Practice Address - Fax:920-465-8195
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18148-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist