Provider Demographics
NPI:1295197440
Name:ADAMS, DOUGLAS
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:CORNWELLS HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19020-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:CORNWELLS HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19020-6000
Practice Address - Country:US
Practice Address - Phone:215-741-9775
Practice Address - Fax:215-741-9777
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045129L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist