Provider Demographics
NPI:1841818549
Name:ESCOTO, ADAM JOSE (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSE
Last Name:ESCOTO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 12TH AVE SE APT 308
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2366
Mailing Address - Country:US
Mailing Address - Phone:702-994-4230
Mailing Address - Fax:
Practice Address - Street 1:5110 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5060
Practice Address - Country:US
Practice Address - Phone:360-252-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61072357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist