Provider Demographics
NPI:1215435599
Name:OLM-SHIPMAN, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:OLM-SHIPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FIELD ST APT B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1944
Mailing Address - Country:US
Mailing Address - Phone:913-660-5024
Mailing Address - Fax:
Practice Address - Street 1:4366 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1206
Practice Address - Country:US
Practice Address - Phone:585-594-5689
Practice Address - Fax:585-594-5712
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102926183500000X
MO2017025931183500000X
NY064275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist