Provider Demographics
NPI:1255916029
Name:SMITH, ADAM J
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:SMITH
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 1:3265 WALKERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7187
Mailing Address - Country:US
Mailing Address - Phone:614-595-0765
Mailing Address - Fax:
Practice Address - Street 1:3535 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3908
Practice Address - Country:US
Practice Address - Phone:614-595-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031355581835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03135558OtherSTATE BOARD OF PHARMACY