=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326491796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM HOYE-SIMEK
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2016
-----------------------------------------------------
Last Update Date | 03/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 1ST ST BLDG 23
-----------------------------------------------------
City | HOLLOMAN AFB
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88330-8273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-774-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 1ST ST BLDG 23
-----------------------------------------------------
City | HOLLOMAN AFB
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88330-8273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-774-8800
-----------------------------------------------------
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 | 36674
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------