Provider Demographics
NPI:1336740612
Name:NEITZEL, ADAM JOSEPH
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOSEPH
Last Name:NEITZEL
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 1:104 WELLINGTON CV
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2700
Mailing Address - Country:US
Mailing Address - Phone:859-374-0726
Mailing Address - Fax:
Practice Address - Street 1:100 WALTON AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8414
Practice Address - Country:US
Practice Address - Phone:859-236-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist