Provider Demographics
NPI:1487926051
Name:ADAMS, ETHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1503
Mailing Address - Country:US
Mailing Address - Phone:509-624-3017
Mailing Address - Fax:509-624-4330
Practice Address - Street 1:6 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1503
Practice Address - Country:US
Practice Address - Phone:509-624-3017
Practice Address - Fax:509-624-4330
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6124567-1701183500000X
ORRPH-0015237183500000X
WAPH60600455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist