Provider Demographics
NPI:1437439957
Name:EDGE, LADONNA ROSE (PARM D)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:ROSE
Last Name:EDGE
Suffix:
Gender:F
Credentials:PARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-1175
Mailing Address - Country:US
Mailing Address - Phone:352-628-3898
Mailing Address - Fax:
Practice Address - Street 1:4029 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-1175
Practice Address - Country:US
Practice Address - Phone:352-628-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 46952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 46952OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION FL MEDICAL QUALITY ASSURANCE