Provider Demographics
NPI:1215024740
Name:MILLWARD, EDWARD T JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:T
Last Name:MILLWARD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-4858
Mailing Address - Country:US
Mailing Address - Phone:814-652-6791
Mailing Address - Fax:814-652-6163
Practice Address - Street 1:33 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1257
Practice Address - Country:US
Practice Address - Phone:814-652-5633
Practice Address - Fax:814-652-6201
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027365L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist