Healthcare Provider Details

I. General information

NPI: 1215760178
Provider Name (Legal Business Name): WAYNE C ADAMS PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S FAIR OAKS AVE STE 200
PASADENA CA
91105-4124
US

IV. Provider business mailing address

11210 APPLEVALE CT
LAS VEGAS NV
89138-8010
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-0099
  • Fax: 626-449-7666
Mailing address:
  • Phone: 702-240-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007618
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number007618
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number007618
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: