Healthcare Provider Details

I. General information

NPI: 1578611794
Provider Name (Legal Business Name): DELICIA ADAMS PHARMD, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DELICIA RUCKER PHARMD, BCGP

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WINGATE DR
CRETE IL
60417-1962
US

IV. Provider business mailing address

401 WINGATE DR
CRETE IL
60417-1962
US

V. Phone/Fax

Practice location:
  • Phone: 708-466-5122
  • Fax:
Mailing address:
  • Phone: 708-466-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051-287-414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: