Provider Demographics
NPI:1114326949
Name:ADAMS PHARMACY, LLC
Entity Type:Organization
Organization Name:ADAMS PHARMACY, LLC
Other - Org Name:ADAMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-478-7823
Mailing Address - Street 1:1373 DIX HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1346
Mailing Address - Country:US
Mailing Address - Phone:313-381-0070
Mailing Address - Fax:313-381-0071
Practice Address - Street 1:1373 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1346
Practice Address - Country:US
Practice Address - Phone:313-381-0070
Practice Address - Fax:313-381-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010107043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy