Healthcare Provider Details

I. General information

NPI: 1821192287
Provider Name (Legal Business Name): DR. CAROLE S ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHN R ST JOHN D DINGELL VA PHARMACY DEPT 118 CP
DETROIT MI
48201
US

IV. Provider business mailing address

12841 SIOUX
REDFORD MI
48239-2787
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax:
Mailing address:
  • Phone: 313-537-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302030646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: