Provider Demographics
NPI:1023579729
Name:EDWARDS, DORIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:EDWARDS
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 1:3804 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-7119
Mailing Address - Country:US
Mailing Address - Phone:410-367-5151
Mailing Address - Fax:410-367-2718
Practice Address - Street 1:3804 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7119
Practice Address - Country:US
Practice Address - Phone:410-367-5151
Practice Address - Fax:410-367-2718
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist