Provider Demographics
NPI:1053835967
Name:EDWARDS, KAYLA DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-4001
Mailing Address - Country:US
Mailing Address - Phone:701-339-0263
Mailing Address - Fax:
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-4001
Practice Address - Country:US
Practice Address - Phone:701-627-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist