Provider Demographics
NPI:1104242338
Name:HAAS, ADAM JUSTIN
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JUSTIN
Last Name:HAAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:SANDLER
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4042 JACARANDA TRCE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-7674
Mailing Address - Country:US
Mailing Address - Phone:850-777-0844
Mailing Address - Fax:
Practice Address - Street 1:421 MARY ESTHER CUT OFF NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4084
Practice Address - Country:US
Practice Address - Phone:850-301-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist