Provider Demographics
NPI:1699102160
Name:CHRISTENSEN, ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CHRISTENSEN
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 1:5514 PERIDOT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4745
Mailing Address - Country:US
Mailing Address - Phone:916-849-9430
Mailing Address - Fax:
Practice Address - Street 1:10451 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1987
Practice Address - Country:US
Practice Address - Phone:916-780-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist