Provider Demographics
NPI:1720795859
Name:DRAHUSHUK, ADAM THOMAS (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THOMAS
Last Name:DRAHUSHUK
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6663 LANGTOFT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2854
Mailing Address - Country:US
Mailing Address - Phone:158-597-0132
Mailing Address - Fax:
Practice Address - Street 1:6663 LANGTOFT ST
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-2854
Practice Address - Country:US
Practice Address - Phone:215-859-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist