Provider Demographics
NPI:1548696305
Name:ADOM, ATTA K (PHARM D)
Entity type:Individual
Prefix:
First Name:ATTA
Middle Name:K
Last Name:ADOM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 N AUSTRALIAN AVE
Mailing Address - Street 2:APT 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2336
Mailing Address - Country:US
Mailing Address - Phone:954-257-2966
Mailing Address - Fax:
Practice Address - Street 1:5271 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2603
Practice Address - Country:US
Practice Address - Phone:305-359-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist