Provider Demographics
NPI:1710261326
Name:AVANTS, EDWARD DAVID (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DAVID
Last Name:AVANTS
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 1:245 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72642-7117
Mailing Address - Country:US
Mailing Address - Phone:870-431-8187
Mailing Address - Fax:
Practice Address - Street 1:350 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3629
Practice Address - Country:US
Practice Address - Phone:870-424-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD09103OtherLOUISIANA 15540