Provider Demographics
NPI:1245710920
Name:JEFFEREY DOUGLAS ADAIR MD
Entity type:Organization
Organization Name:JEFFEREY DOUGLAS ADAIR MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NCPDP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-296-3757
Mailing Address - Street 1:200 RITTENHOUSE CIRCLE
Mailing Address - Street 2:EAST BUILDING STE 5
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007
Mailing Address - Country:US
Mailing Address - Phone:855-295-3757
Mailing Address - Fax:866-740-4689
Practice Address - Street 1:8860 FERN AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-841-9999
Practice Address - Fax:318-841-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.020437332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site