Provider Demographics
NPI:1497974042
Name:CALLAHAN, EDWARD LEO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEO
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WATERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8050
Mailing Address - Country:US
Mailing Address - Phone:310-821-5998
Mailing Address - Fax:310-306-1748
Practice Address - Street 1:123 W. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90248-3103
Practice Address - Country:US
Practice Address - Phone:310-515-8425
Practice Address - Fax:310-515-8426
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 26227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist