Provider Demographics
NPI:1609091107
Name:ADAMS, JEFFERY R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:R
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 1:7460 COMANCHE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3024
Mailing Address - Country:US
Mailing Address - Phone:702-358-8330
Mailing Address - Fax:
Practice Address - Street 1:1961 S LAS VEGAS BLVD #101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3024
Practice Address - Country:US
Practice Address - Phone:702-650-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist