Provider Demographics
NPI:1437252632
Name:EDGIN, ROBERT GERALD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GERALD
Last Name:EDGIN
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 1:563 CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:HORATIO
Mailing Address - State:AR
Mailing Address - Zip Code:71842-8847
Mailing Address - Country:US
Mailing Address - Phone:870-832-5816
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN DR
Practice Address - Street 2:RED RIVER COMMERCE PARK
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-9534
Practice Address - Country:US
Practice Address - Phone:800-503-7604
Practice Address - Fax:866-300-9797
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist