Provider Demographics
NPI:1891077715
Name:FUNK, ADAM JOSEPH
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOSEPH
Last Name:FUNK
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 1:5050 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1402
Mailing Address - Country:US
Mailing Address - Phone:317-479-1476
Mailing Address - Fax:317-255-3440
Practice Address - Street 1:5050 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1402
Practice Address - Country:US
Practice Address - Phone:317-479-1476
Practice Address - Fax:317-255-3440
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019566A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist