Provider Demographics
NPI:1669012233
Name:ADAMS, WILLIAM TODD
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TODD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 WALLER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2910
Mailing Address - Country:US
Mailing Address - Phone:859-276-3905
Mailing Address - Fax:
Practice Address - Street 1:399 WALLER AVE STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2910
Practice Address - Country:US
Practice Address - Phone:859-276-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist