Provider Demographics
NPI:1154497378
Name:SCOTT A EDMUNDSON
Entity Type:Organization
Organization Name:SCOTT A EDMUNDSON
Other - Org Name:TRAFFORD FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-372-5493
Mailing Address - Street 1:312 CAVITT AVE
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1065
Mailing Address - Country:US
Mailing Address - Phone:412-372-5493
Mailing Address - Fax:412-372-5493
Practice Address - Street 1:312 CAVITT AVE
Practice Address - Street 2:
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-1065
Practice Address - Country:US
Practice Address - Phone:412-372-5493
Practice Address - Fax:412-372-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410571L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018255900001Medicaid
3936549OtherNCPDP PROVIDER IDENTIFICATION NUMBER