Provider Demographics
NPI:1396015624
Name:ADAMS, EDGAR LEON JR
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:LEON
Last Name:ADAMS
Suffix:JR
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 1:5701 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4834
Mailing Address - Country:US
Mailing Address - Phone:727-344-3701
Mailing Address - Fax:727-343-1501
Practice Address - Street 1:5701 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4834
Practice Address - Country:US
Practice Address - Phone:727-344-3701
Practice Address - Fax:727-343-1501
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist