Provider Demographics
NPI:1043736937
Name:EDWARDS, ROGER DEAN
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DEAN
Last Name:EDWARDS
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 1:4061 MINNESOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3541
Mailing Address - Country:US
Mailing Address - Phone:202-388-3100
Mailing Address - Fax:202-388-3102
Practice Address - Street 1:4061 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3541
Practice Address - Country:US
Practice Address - Phone:202-388-3100
Practice Address - Fax:202-388-3102
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146M00000X
WALP00016283164W00000X
WAPH000104281835C0205X, 1835P0018X, 1835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care