Provider Demographics
NPI:1033320270
Name:ADAMS, RUSSELL ROGERS (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ROGERS
Last Name:ADAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-5138
Mailing Address - Country:US
Mailing Address - Phone:229-273-5217
Mailing Address - Fax:
Practice Address - Street 1:408 E 16TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1699
Practice Address - Country:US
Practice Address - Phone:229-273-3433
Practice Address - Fax:229-273-0580
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist