MEDICARE: DR. BETTINA J. ADAMS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	E-010131	MS

General Provider Information

NPI Number	:	1588972004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTINA J. ADAMS PHARM.D.

Provider Business Mailing Address
First Line	:	2885 TERRY RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3051
Country	:	US
Telephone Number	:	601-373-6783
Fax Number	:	601-371-9137

Provider Business Practice Location Address
First Line	:	2885 TERRY RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3051
Country	:	US
Telephone Number	:	601-373-6783
Fax Number	:	601-371-9137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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