Healthcare Provider Details

I. General information

NPI: 1235677329
Provider Name (Legal Business Name): MARY ADAME PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5954 BEAUMERE WAY
CARMICHAEL CA
95608-0404
US

IV. Provider business mailing address

5954 BEAUMERE WAY
CARMICHAEL CA
95608-0404
US

V. Phone/Fax

Practice location:
  • Phone: 916-534-4662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: