Provider Demographics
NPI:1629751631
Name:EDWARDS, TALIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 S US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1130
Mailing Address - Country:US
Mailing Address - Phone:816-777-2448
Mailing Address - Fax:
Practice Address - Street 1:12220 S US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1130
Practice Address - Country:US
Practice Address - Phone:816-777-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023030437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist