MEDICARE: ADIO PHARMACY DISTRIBUTION SERVICES

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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	P06845	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2034082	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992710511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIO PHARMACY DISTRIBUTION SERVICES

Provider Business Mailing Address
First Line	:	415 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-0713
Country	:	US
Telephone Number	:	270-538-0772
Fax Number	:	270-538-0773

Provider Business Practice Location Address
First Line	:	415 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-0713
Country	:	US
Telephone Number	:	270-538-0772
Fax Number	:	270-538-0773

Authorized Official
Title or Position	:	OWNER
Name	:	VICTOR SWAMI
Credential	:
Telephone Number	:	270-538-0772

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/09/2015

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