Provider Demographics
NPI:1043816085
Name:ADAMS, AJA ELISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AJA
Middle Name:ELISE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3698 SW PISANO ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3600
Mailing Address - Country:US
Mailing Address - Phone:313-690-1413
Mailing Address - Fax:
Practice Address - Street 1:2220 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5154
Practice Address - Country:US
Practice Address - Phone:772-464-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist