Provider Demographics
NPI:1205142577
Name:ADAMS, PAT (RPH)
Entity type:Individual
Prefix:MR
First Name:PAT
Middle Name:
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 1:1102 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2883
Mailing Address - Country:US
Mailing Address - Phone:337-560-1807
Mailing Address - Fax:337-560-4129
Practice Address - Street 1:1102 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2883
Practice Address - Country:US
Practice Address - Phone:337-560-1807
Practice Address - Fax:337-560-4129
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist