Healthcare Provider Details

I. General information

NPI: 1730184953
Provider Name (Legal Business Name): ADAM D BOON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 16TH ST
BEDFORD IN
47421-3510
US

IV. Provider business mailing address

1419 S NANCY ST
BLOOMINGTON IN
47401-6051
US

V. Phone/Fax

Practice location:
  • Phone: 812-275-1200
  • Fax:
Mailing address:
  • Phone: 812-339-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26021100A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: