Provider Demographics
NPI:1043284896
Name:ADAM, MARY BETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:20760 310TH AVE
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:IA
Mailing Address - Zip Code:52231-8776
Mailing Address - Country:US
Mailing Address - Phone:641-636-2113
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:CORNER DRUG STORE
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-1414
Practice Address - Country:US
Practice Address - Phone:641-622-3184
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAM17264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist