Provider Demographics
NPI:1508207002
Name:ADAMS, IZELL RICARDO (NUCLEAR PHARMACY)
Entity Type:Individual
Prefix:
First Name:IZELL
Middle Name:RICARDO
Last Name:ADAMS
Suffix:
Gender:M
Credentials:NUCLEAR PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7362
Mailing Address - Country:US
Mailing Address - Phone:813-404-5448
Mailing Address - Fax:
Practice Address - Street 1:7023 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7362
Practice Address - Country:US
Practice Address - Phone:813-404-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21238183500000X
FLNP3671835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
No183500000XPharmacy Service ProvidersPharmacist