Provider Demographics
NPI:1205018850
Name:ADAMS, ANGEL LYNN
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 STATE HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3205
Mailing Address - Country:US
Mailing Address - Phone:607-336-2588
Mailing Address - Fax:866-301-6005
Practice Address - Street 1:5631 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3205
Practice Address - Country:US
Practice Address - Phone:607-336-2588
Practice Address - Fax:866-301-6005
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048924Medicaid