Provider Demographics
NPI:1376826081
Name:ASIEDU, EDITH REGINA (BS PHARM)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:REGINA
Last Name:ASIEDU
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:ASIEDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSPHARM
Mailing Address - Street 1:472 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1917
Mailing Address - Country:US
Mailing Address - Phone:508-856-7923
Mailing Address - Fax:508-856-7929
Practice Address - Street 1:472 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1917
Practice Address - Country:US
Practice Address - Phone:508-856-7923
Practice Address - Fax:508-856-7929
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist