Provider Demographics
NPI:1891760377
Name:GORAM, ADRIAN LAERTES (PHARM D)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LAERTES
Last Name:GORAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 BAMBOO DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526
Mailing Address - Country:US
Mailing Address - Phone:850-944-7368
Mailing Address - Fax:850-944-7428
Practice Address - Street 1:2237 W 9 MILE RD
Practice Address - Street 2:WALGREENS STORE 10181
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534
Practice Address - Country:US
Practice Address - Phone:850-473-0286
Practice Address - Fax:850-473-0579
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22060183500000X
AL11692183500000X
VA0202012246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist