Provider Demographics
NPI:1811337512
Name:ROOT, ADAM GEORGE (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GEORGE
Last Name:ROOT
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 1:5602 LOCKE ST
Mailing Address - Street 2:APT 206
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1964
Mailing Address - Country:US
Mailing Address - Phone:814-553-4813
Mailing Address - Fax:
Practice Address - Street 1:4501 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3419
Practice Address - Country:US
Practice Address - Phone:910-799-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist