Provider Demographics
NPI:1598066466
Name:EDLEN, NEIL LUCAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:LUCAS
Last Name:EDLEN
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:PO BOX 6713
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-6713
Mailing Address - Country:US
Mailing Address - Phone:850-776-3804
Mailing Address - Fax:
Practice Address - Street 1:364 N SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3532
Practice Address - Country:US
Practice Address - Phone:850-776-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP1779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist