MEDICARE: MR. JEFFERY R ADAMS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15557	NV

General Provider Information

NPI Number	:	1609091107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY R ADAMS RPH

Provider Business Mailing Address
First Line	:	7460 COMANCHE CANYON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3024
Country	:	US
Telephone Number	:	702-358-8330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 S LAS VEGAS BLVD #101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3024
Country	:	US
Telephone Number	:	702-650-4417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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