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NPI Code Detail

MEDICARE: DR. ADAM KEITH GOURLEY PHARMD

MEDICARE: DR. ADAM KEITH GOURLEY PHARMD
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
1183500000XPharmacist5302037769MI
2183500000XPharmacist26022330AIN

General Provider Information

NPI Number : 1881976694
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM KEITH GOURLEY PHARMD
Provider Business Mailing Address
First Line : 5032 N 500 E
Second Line :
City : ROLLING PRAIRIE
State : IN
Zip : 46371-9734
Country : US
Telephone Number : 219-363-5795
Fax Number :
Provider Business Practice Location Address
First Line : 1710 W JOHN BEERS RD
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9409
Country : US
Telephone Number : 269-429-1153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2011
Last Update Date : 09/16/2011

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