=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104625607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM ADE RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 MONTAUK HWY
-----------------------------------------------------
City | EAST QUOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11942-3943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-653-3784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 MINUTEMAN CT
-----------------------------------------------------
City | MILLER PLACE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11764-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 072470-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------