Healthcare Provider Details

I. General information

NPI: 1710258660
Provider Name (Legal Business Name): ADAM HUTH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 N 14TH ST
SHEBOYGAN WI
53081-3813
US

IV. Provider business mailing address

1029 N 14TH ST
SHEBOYGAN WI
53081-3813
US

V. Phone/Fax

Practice location:
  • Phone: 920-458-7707
  • Fax:
Mailing address:
  • Phone: 920-458-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17536-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: