Provider Demographics
NPI:1114280161
Name:ADAMS, CHARLES DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 JACARANDA LN
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4617
Mailing Address - Country:US
Mailing Address - Phone:805-528-2328
Mailing Address - Fax:805-528-1237
Practice Address - Street 1:2585 JACARANDA LN
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-4617
Practice Address - Country:US
Practice Address - Phone:805-528-2328
Practice Address - Fax:805-528-1237
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist