Provider Demographics
NPI:1396021903
Name:ADAMOVICS, GRACE J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:J
Last Name:ADAMOVICS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3727
Mailing Address - Country:US
Mailing Address - Phone:209-830-2955
Mailing Address - Fax:209-830-2959
Practice Address - Street 1:1801 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3727
Practice Address - Country:US
Practice Address - Phone:209-830-2955
Practice Address - Fax:209-830-2959
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist