Provider Demographics
NPI:1710262894
Name:JUSTICE, EDWARD ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALLEN
Last Name:JUSTICE
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 1:700 E OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2332
Mailing Address - Country:US
Mailing Address - Phone:772-287-4049
Mailing Address - Fax:772-286-7341
Practice Address - Street 1:700 E OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2332
Practice Address - Country:US
Practice Address - Phone:772-287-4049
Practice Address - Fax:772-286-7341
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26501OtherPHARMACIST LISCENSE NUMBER