Provider Demographics
NPI:1831523497
Name:TOMBERLIN, ADAM TAYLOR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:TAYLOR
Last Name:TOMBERLIN
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 1:12500 S WESTERN AVE
Mailing Address - Street 2:APT 42
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5905
Mailing Address - Country:US
Mailing Address - Phone:405-570-7987
Mailing Address - Fax:
Practice Address - Street 1:9011 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6932
Practice Address - Country:US
Practice Address - Phone:405-692-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist