Provider Demographics
NPI:1518565902
Name:EDEH, EDWARD (PHARM D)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:EDEH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 S HAIRSTON RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2715
Mailing Address - Country:US
Mailing Address - Phone:404-292-5542
Mailing Address - Fax:
Practice Address - Street 1:1232 SOUTH HAIRSTOH ROAD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088
Practice Address - Country:US
Practice Address - Phone:404-292-5542
Practice Address - Fax:404-292-5582
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0145611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist