MEDICARE: ADHAM ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	022301850	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141009	OTHER		PK

General Provider Information

NPI Number	:	1497195655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADHAM ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2800 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2750
Country	:	US
Telephone Number	:	937-274-5500
Fax Number	:	937-274-5505

Provider Business Practice Location Address
First Line	:	2800 SALEM AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2750
Country	:	US
Telephone Number	:	937-274-5500
Fax Number	:	937-274-5505

Authorized Official
Title or Position	:	RPH/OWNER
Name	:	HOUSAM ABDELHAMID
Credential	:
Telephone Number	:	937-274-5500

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	07/02/2013

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Directions to “ADHAM ENTERPRISES LLC ” Practice Location

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