=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972957223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM REEL PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2016
-----------------------------------------------------
Last Update Date | 04/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 934 MAIN ST
-----------------------------------------------------
City | SABETHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66534-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-284-3414
-----------------------------------------------------
Fax | 785-284-3040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 934 MAIN ST
-----------------------------------------------------
City | SABETHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66534-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-284-3414
-----------------------------------------------------
Fax | 785-284-3040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 1-14466
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------