Provider Demographics
NPI:1548210586
Name:HORTON, EDMUND ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:ROBERT
Last Name:HORTON
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 1:2445 NORTHWEST LOOP
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1705
Mailing Address - Country:US
Mailing Address - Phone:125-496-8765
Mailing Address - Fax:125-496-8036
Practice Address - Street 1:2445 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1704
Practice Address - Country:US
Practice Address - Phone:125-496-8765
Practice Address - Fax:125-496-8036
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21004OtherPHARMACIST