Healthcare Provider Details

I. General information

NPI: 1558357848
Provider Name (Legal Business Name): VIRGENE KIETH ADAMS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6607 CANYON LAKE DR
FRISCO TX
75034-3285
US

IV. Provider business mailing address

6607 CANYON LAKE DR
FRISCO TX
75034-3285
US

V. Phone/Fax

Practice location:
  • Phone: 214-417-4577
  • Fax: 214-417-4577
Mailing address:
  • Phone: 214-417-4577
  • Fax: 214-417-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: