Healthcare Provider Details

I. General information

NPI: 1083295562
Provider Name (Legal Business Name): ZACHRY LANE ADORNETTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 12/14/2025
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 191, HOSPITAL ROAD
CHINLE AZ
86503
US

IV. Provider business mailing address

15200 HIGHWAY 152
MOBEETIE TX
79061-4712
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-8114
  • Fax:
Mailing address:
  • Phone: 432-413-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67740
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19010
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: