Provider Demographics
NPI:1457940199
Name:DEISENROTH, ADAM (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DEISENROTH
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 NEW LEICESTER HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2123
Mailing Address - Country:US
Mailing Address - Phone:828-771-0512
Mailing Address - Fax:
Practice Address - Street 1:578 NEW LEICESTER HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2123
Practice Address - Country:US
Practice Address - Phone:828-771-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist