Provider Demographics
NPI:1174033872
Name:EDWARDS, CHERISSE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHERISSE
Middle Name:M
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 1:3977 HIGH CHAPARRAL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5109
Mailing Address - Country:US
Mailing Address - Phone:803-707-6496
Mailing Address - Fax:
Practice Address - Street 1:3977 HIGH CHAPARRAL DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5109
Practice Address - Country:US
Practice Address - Phone:803-707-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022860183500000X
SC10641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist