Provider Demographics
NPI:1073678850
Name:EDWARD S. WILCOX
Entity Type:Organization
Organization Name:EDWARD S. WILCOX
Other - Org Name:REDSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-246-8800
Mailing Address - Street 1:1009 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:PA
Mailing Address - Zip Code:15475
Mailing Address - Country:US
Mailing Address - Phone:724-246-8800
Mailing Address - Fax:724-246-5050
Practice Address - Street 1:1009 MAIN ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:PA
Practice Address - Zip Code:15475
Practice Address - Country:US
Practice Address - Phone:724-246-8800
Practice Address - Fax:724-246-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411751L332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000563349Medicaid
0858370001Medicare NSC
1073678850Medicare UPIN