Provider Demographics
NPI:1720675085
Name:ADAMS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:30148 W COLON RD
Mailing Address - Street 2:
Mailing Address - City:COLON
Mailing Address - State:MI
Mailing Address - Zip Code:49040-9523
Mailing Address - Country:US
Mailing Address - Phone:574-298-3560
Mailing Address - Fax:
Practice Address - Street 1:30148 W COLON RD
Practice Address - Street 2:
Practice Address - City:COLON
Practice Address - State:MI
Practice Address - Zip Code:49040-9523
Practice Address - Country:US
Practice Address - Phone:574-298-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26018166AOtherINDIANA BOARD OF PHARMACY
MI5302028405OtherMICHIGAN BOARD OF PHARMACY