Healthcare Provider Details

I. General information

NPI: 1255833018
Provider Name (Legal Business Name): MADISON LEE ADAMS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 491 N PHARMACY DEPT
SHIPROCK NM
87420
US

IV. Provider business mailing address

1308 SMITH LN
FARMINGTON NM
87401-7635
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6000
  • Fax:
Mailing address:
  • Phone: 330-401-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451442
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: