Provider Demographics
NPI:1427511385
Name:NELSON, ADAM LEE
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 4TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1095
Mailing Address - Country:US
Mailing Address - Phone:406-396-0987
Mailing Address - Fax:
Practice Address - Street 1:202 FRONT ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1228
Practice Address - Country:US
Practice Address - Phone:907-586-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHAP1960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPHAP1960OtherPHARMACIST LICENSE