Provider Demographics
NPI:1417298019
Name:EDGAR, CHAD ALLEN (PHARMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALLEN
Last Name:EDGAR
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 JOHNSON ST
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5421
Mailing Address - Country:US
Mailing Address - Phone:954-265-5132
Mailing Address - Fax:954-985-2207
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-5132
Practice Address - Fax:954-985-2207
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS401961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist