Provider Demographics
NPI:1467076232
Name:WILCOX, ADAM JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:WILCOX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3714
Mailing Address - Country:US
Mailing Address - Phone:216-561-4007
Mailing Address - Fax:216-561-7280
Practice Address - Street 1:16400 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-3714
Practice Address - Country:US
Practice Address - Phone:216-561-4007
Practice Address - Fax:216-561-7280
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist