Provider Demographics
NPI:1417165317
Name:EDWARDS, ERIC (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:EDWARDS
Suffix:
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 1:6813 FARRAHS CAVALRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2597
Mailing Address - Country:US
Mailing Address - Phone:703-449-8399
Mailing Address - Fax:
Practice Address - Street 1:409 3RS ST SW
Practice Address - Street 2:SUITE # 330
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20401-0001
Practice Address - Country:US
Practice Address - Phone:202-205-8082
Practice Address - Fax:800-872-5945
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029157-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist