Provider Demographics
NPI:1497535140
Name:EDWARDS, KIRSTEN MICHELLE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALHOUN PLZ
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2423
Mailing Address - Country:US
Mailing Address - Phone:361-552-4563
Mailing Address - Fax:
Practice Address - Street 1:101 CALHOUN PLZ
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2423
Practice Address - Country:US
Practice Address - Phone:361-552-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195159183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician