Provider Demographics
NPI:1376810952
Name:EDWARDS, CURTIS J
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1597
Mailing Address - Country:US
Mailing Address - Phone:219-865-0726
Mailing Address - Fax:
Practice Address - Street 1:2601 E SAUK TRL
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5262
Practice Address - Country:US
Practice Address - Phone:708-757-6906
Practice Address - Fax:708-757-7867
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-035260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist