Provider Demographics
NPI:1346842127
Name:EDWARDS, KEVIN LEE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E WALLISVILLE RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-3831
Mailing Address - Country:US
Mailing Address - Phone:832-838-8560
Mailing Address - Fax:832-838-8468
Practice Address - Street 1:607 E WALLISVILLE RD BLDG 1
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-3831
Practice Address - Country:US
Practice Address - Phone:832-838-8560
Practice Address - Fax:832-838-8468
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist