Provider Demographics
NPI:1942579990
Name:ADAMS, SHANA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3569
Mailing Address - Country:US
Mailing Address - Phone:763-544-1747
Mailing Address - Fax:763-544-0115
Practice Address - Street 1:2500 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-3569
Practice Address - Country:US
Practice Address - Phone:763-544-1747
Practice Address - Fax:763-544-0115
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist