Provider Demographics
NPI:1568450914
Name:GIFFORD, EDWARD K (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:K
Last Name:GIFFORD
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 1:1030 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6229
Mailing Address - Country:US
Mailing Address - Phone:307-672-7705
Mailing Address - Fax:307-672-7705
Practice Address - Street 1:362 COFFEEN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4809
Practice Address - Country:US
Practice Address - Phone:307-672-7705
Practice Address - Fax:307-672-7705
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY25691835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support