Provider Demographics
NPI:1568984003
Name:ADAMS, MARVIN EUGENE JR (DPH)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:EUGENE
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8211
Mailing Address - Country:US
Mailing Address - Phone:901-624-5720
Mailing Address - Fax:901-624-5722
Practice Address - Street 1:6500 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8211
Practice Address - Country:US
Practice Address - Phone:901-624-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5051OtherTENNESSEE STATE BOARD OF PHARMACY