Provider Demographics
NPI:1972675759
Name:STEPHEN D ADAMS PHARMACIES INC
Entity Type:Organization
Organization Name:STEPHEN D ADAMS PHARMACIES INC
Other - Org Name:LAWRENCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-532-0186
Mailing Address - Street 1:631 BROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3729
Mailing Address - Country:US
Mailing Address - Phone:770-532-0186
Mailing Address - Fax:770-503-1016
Practice Address - Street 1:631 BROAD ST SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3729
Practice Address - Country:US
Practice Address - Phone:770-532-0186
Practice Address - Fax:770-503-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
GAPHRE0078863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00673219AMedicaid
2012378OtherPK
2012378OtherPK