Provider Demographics
NPI:1609312743
Name:ADAMS, PHILIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:ADAMS
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 1:1959 S FARM ROAD 123
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7863
Mailing Address - Country:US
Mailing Address - Phone:417-496-5628
Mailing Address - Fax:
Practice Address - Street 1:1155 E SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2527
Practice Address - Country:US
Practice Address - Phone:417-862-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist