Provider Demographics
NPI:1568901692
Name:SPECK, EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SPECK
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 1:2124 YOUNGS CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6320
Mailing Address - Country:US
Mailing Address - Phone:925-899-6697
Mailing Address - Fax:
Practice Address - Street 1:2124 YOUNGS CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-6320
Practice Address - Country:US
Practice Address - Phone:925-899-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist