Provider Demographics
NPI:1558357848
Name:ADAMS, VIRGENE KIETH (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIRGENE
Middle Name:KIETH
Last Name:ADAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3285
Mailing Address - Country:US
Mailing Address - Phone:214-417-4577
Mailing Address - Fax:214-417-4577
Practice Address - Street 1:6607 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3285
Practice Address - Country:US
Practice Address - Phone:214-417-4577
Practice Address - Fax:214-417-4577
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist