Healthcare Provider Details

I. General information

NPI: 1871543686
Provider Name (Legal Business Name): SAMUEL B ADAMS JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S SHADY ST
MOUNTAIN CITY TN
37683-1831
US

IV. Provider business mailing address

239 ADAMS LN PO BOX 413
MOUNTAIN CITY TN
37683-6113
US

V. Phone/Fax

Practice location:
  • Phone: 423-727-1210
  • Fax: 423-727-1368
Mailing address:
  • Phone: 423-727-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberC8222
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: