Provider Demographics
NPI:1891387718
Name:ADLICH, DOMINICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:ADLICH
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 1:545 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1437
Mailing Address - Country:US
Mailing Address - Phone:660-259-3455
Mailing Address - Fax:
Practice Address - Street 1:508 JOHNNY WALKER LN STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1804
Practice Address - Country:US
Practice Address - Phone:816-776-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020023096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist